Supporting People who use AAC

Strategies: in the Home, School

& Community.

Fourth Edition - February 2008

Supporting People who use AAC Strategies: in the Home, School and
Community
© 2008

This document is published by Special Education Technology - British

Columbia, a provincial resource program of the BC Ministry of Education.
It is based on the previous work by this group, a document called “AAC: A
Way of Thinking”.

Acknowledgements

Contributors to this guide:

Linda Calliou, SET-BC, Region 2, Lower Mainland/Southwest BC
Suzanne Harwood, SET-BC, Region 1, Vancouver Island / Central Coast
Anne MacCallum, Assistive Technology & Seating Service, G. F. Strong
Rehab Centre
Jeff Riley, CAYA – Communication Assistance for Young Adults
Kathy Ryan, SET-BC, Region 3, Okanagan
Lois Turner, CAYA – Communication Assistance for Young Adults

Most of the examples of communication overlays in this guide were created

using BoardmakerTM software, from Mayer-Johnson, Inc.
 Table of Contents

Introduction
About SET-BC ........................................................................................................................... 5
About CAYA ............................................................................................................................... 5
About ATSS ............................................................................................................................... 6
Preamble ................................................................................................................................... 7
AAC Myths Dispelled ................................................................................................................. 8

Section 1: Planning for the Use of AAC Technologies

Team Roles ............................................................................................................................. 10
Including People Who Use AAC ............................................................................................... 13
Assessment ............................................................................................................................. 16
System Components ................................................................................................................ 18
Transitions ............................................................................................................................... 21

Section 2: AAC Intervention

Intervention Models, Approaches and Techniques .................................................................... 23
Communicative Independence ..................................................................................... 23
Participation................................................................................................................... 23
Communicative Competence ......................................................................................... 24
Social Networks............................................................................................................. 25
Development ................................................................................................................ 25
Routines/Choice Making/Matrices ................................................................................. 25
Second Language Learning .......................................................................................... 27
Prompting/Fading ......................................................................................................... 27
System for Augmenting Language (SAL)/Aided Language Stimulation/
Augmented Input .......................................................................................................... 28
Partner Assisted Scanning ........................................................................................... 29
PODD: Pragmatic Organization Dynamic Displays ....... ..................................................29
Message Selection ................................................................................................................... 30
Factors Influencing Selection ......................................................................................... 30
Types of Messages ...................................................................................................... 32
 Examples of Symbols Sets ............................................................................................ 33
Literacy & AAC ......................................................................................................................... 35
Emergent Literacy ......................................................................................................... 35
Key Factors in Learning to Read ................................................................................... 36
Balanced Literacy Instruction ......................................................................................... 37
Using an AAC System as a Tool for Literacy ................................................................ 37
AAC Outcomes ........................................................................................................................ 39
Collecting data .............................................................................................................. 39
Analyzing data ............................................................................................................... 41
Reporting data ............................................................................................................... 42

Section 3: Voice Output Communication Aids

Technical & Non-Technical Communication Systems .............................................................. 43
Single Choice Message Devices .............................................................................................. 44
Multiple Choice Message Devices ............................................................................................ 47
Dynamic Display Devices & Software ...................................................................................... 50
Icon Sequencing Devices ......................................................................................................... 55
Text-to-Speech Devices & Software ......................................................................................... 58

Appendices: References & Resources

Appendix A: Glossary ............................................................................................................... 61
Appendix B: References ........................................................................................................... 70
Appendix C: Resources in BC .................................................................................................. 75
Appendix D: Websites .............................................................................................................. 76
 Supporting People who use AAC Strategies

Introduction
This document describes the SET-BC CAYA process and considerations for students and
clients moving through this continuum. The professionals who contributed to the writing of this
document are employed in three provincial technology programs in British Columbia: SET-BC,
CAYA and the ATSS at GF Strong. These programs operate in slightly different ways to provide
AAC services. For information on other AAC services in BC, refer to the “AAC Services in BC”
handout in appendix C.

SET-BC:
Special Education Technology - British Columbia (SET-BC) is a provincial government initiative
established to assist school districts and Group 1 and 2 independent schools in educating
students with physical disabilities, visual impairments or autism through the use of technology.

SET-BC‟s mandate is:

to lend assistive technologies where required to facilitate students‟ access to educational
programs, and
to assist school districts in providing the necessary consultation and training for students
and educators in the use of these technologies.

SET-BC services to school districts include:

consultation, planning and follow-up for school based teams
loan and maintenance of assistive technology
training
provision of resources and information

SET-BC consultants are based in seven Regional Centres around the province, providing
community based services to all BC school districts. Each district has a SET-BC District Partner
who can provide information on how services are provided for eligible students. For more
information and resources on assistive technology, check SET-BC‟s web site at www.setbc.org.

CAYA:
Communication Assistance for Young Adults (CAYA) is a provincial initiative funded through the
Ministry of Employment and Income Assistance to support adults from 19-27 years of age who
require AAC (Augmentative & Alternative Communication) assistance.

CAYA offers services in five areas:

Individuals in transition - CAYA provides communication assistance to students leaving the
K-12 education system.
Assessment – young adults who are within the age mandate are eligible for CAYA
assessment services to have their communication systems updated (both electronic and lite-
tech systems).
Equipment - CAYA maintains a loan bank of AAC devices and provides technical support
services for those devices.
Training and Resources – individualized training, small group sessions and large group
workshops will be provided as necessary. Online modules and resource packages are also
offered through the SET-BC Learning Centre.

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Follow-up - CAYA staff will help update communication systems for young adults who are
within the age mandate.

CAYA employs staff in the following areas of the province: Lower Mainland, Fraser Valley,
Okanagan, Vancouver Island and the North. A travelling Speech Language Pathologist will
consult and support people who use AAC and live in smaller communities as necessary. For
more information and resources, please go to the CAYA website at www.cayabc.org

ATSS:
The Assistive Technology Seating Service is part of the services offered by the GF Strong
Rehabilitation Centre and provides technology related services to adults with disabilities.
Assistive Technology Consultants and AAC Clinical Specialists are available for phone or email
consultation to Clinicians in BC and the Yukon. ATSS offers assessment, consultation and
training in the following areas:
Computer access
Environmental control
Specialized seating
AAC, device access and mounting

ATSS maintains a loan bank for short term trial of AAC, environmental control and computer
access technologies. For more information on access solutions and AAC, go to www.assistive-
technology.ca

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 Supporting People who use AAC Strategies

Preamble
The purpose of this guide is to introduce augmentative and alternative communication (AAC) as
a way of thinking about the total process of communication. This guide will present
considerations for people who are supporting non-verbal individuals, including long-term
planning, intervention models and strategies for utilizing technical and non-technical
augmentative communication systems within their school, home and community.

Communication is a basic need and individual right of all human beings. These interactions are
an essential part of our society and culture. The general purposes of communication are:
to socialize and to interact with others.
to exchange information
to make requests

Expressive communication includes a variety of modes, such as speech, pointing, gestures and
writing. The term augmentative and alternative communication is used to describe expressive
communication methods other than verbal speech, for example; sign language, gestures, and
alphabet or picture systems.

The person who has difficulty communicating verbally may need to use other communication
methods, including electronic AAC systems. These systems can generically be called: voice
output communication aids (VOCAs), speech generating devices (SGDs) and dedicated
communication devices. Electronic methods of communication require supplementary and/or
back-up non-electronic systems.

Individuals who can successfully coordinate their use of an appropriate AAC system will:
exercise control of their lives
develop independence
interact with others and express their wishes
become productive, active members of society

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 Supporting People who use AAC Strategies

AAC Myths Dispelled

We all approach a challenge with certain assumptions. Often, these assumptions can get us
going, but will trip us up at a later date. In order for readers to start their journey towards „a way
of thinking‟, here are some common myths that people have about AAC, and a brief description
of what is currently known about AAC.

Myth #1: AAC is only used by people who cannot communicate verbally.
Truth: AAC can be used by a wide variety of communicators. We all augment our verbal
communication with gestures, facial expressions and so forth.

Myth #2: The primary goal of communication is to express wants and needs.
Truth: For most people, in most situations, expressing wants and needs is secondary to
social expression. One way to think of this is to put yourself into the position of a person who
uses AAC. If you could only say three things, would they be “I need to go to the toilet”, “I‟m
hungry”, and “I‟m thirsty”, or would they be “Hi, how are you”, “Can we talk?”, and “I love
you”? This is not to say that being able to control your environment is not important, but it
may not be the most important (or motivating) thing.

Myth #3: Using AAC will delay speech development.

Truth: Studies show that the use of AAC actually improves speech development where
possible (Silverman 1995), and it can be argued that it improves language development in
all cases. But it should be noted that even the most sophisticated voice output
communication aid cannot be as efficient or smooth as good speech.

Myth #4: We should wait to use AAC until a person is ready for it.
Truth: Anybody can use AAC. We do not wait to communicate verbally with a typical child
until they are ready to talk; rather, we surround them with a wealth of language. The same
can be said for someone who uses AAC. We should not wait to introduce other methods of
communication until they are ready to use them; rather we should surround them with a
wealth of language (verbal, gestural or symbolically based).

Myth #5: We should not overwhelm somebody with access to too many symbols.
Truth: We should provide more symbols than a person can use at one time. Again, if we
look at typically developing children, they have access to all the sounds of their language by
6 months of age. They use them appropriately when they are able to. The same can be said
for people communicating with symbols. If they are not provided with any more symbols than
they have „mastery‟ of, then they have no opportunity to practice new symbols when they
are ready.

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Myth #6: Somebody who has a VOCA should use it all the time.
Truth: Voice output communication aids (VOCAs) are often vital components of a
individual‟s AAC system. It is true that they should have access to the device all the time (or
almost all the time). But, there are times when it is not practical or necessary. For example,
using a VOCA in the bath is not usually a good idea. Communication is, in its nature, multi-
modal; for example, there are people who use VOCAs in many situations, but not at home
with their family.

Myth #7: An AAC system should be a goal for all people who are non-verbal.
Truth: The „goal‟ is to have functional communication. An AAC system may be a useful tool
towards that end. This distinction, while subtle, can help tremendously towards setting
appropriate goals for a person.

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 Supporting People who use AAC Strategies

Section 1: Planning for the Use of AAC Technologies

Team Roles
Making decisions around the use of augmentative and alternative communication systems
needs to have the full involvement of team members. Gathering and sharing information from all
members of the team, and combining knowledge and expertise through the process of planning,
will lead to well informed and thoughtful decisions. These carefully made decisions will go a long
way toward making implementation of any AAC system successful.

It is important that this group of individuals create a collaborative working environment where all
the facets of a person‟s communication needs can be considered. Key members of the team, for
the process of designing and implementing an AAC system, may include:
individual user, family and group home staff
speech language pathologist
teachers or community day staff
occupational therapist
educational assistants or human service workers

As with any group striving to make changes or implement programs, it is important to identify a
team leader. This person can be anyone who will take the responsibility for planning meetings,
keeping records, setting goals, and ensuring action is taken. Without a team leader, the
program for the person using AAC may not have a clear direction and the effort spent in
planning may be wasted. A strong commitment for the long-term, ongoing development of an
appropriate AAC system is important for all team members, but it is especially important from
the team leader.

The plan will include:

assessment and selection of a symbol system
how it will be used
general and situation specific vocabulary
flexibility of the system
use in a variety of situations
who is responsible for the system maintenance and revisions
how the team shares information

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 Supporting People who use AAC Strategies

SET-BC Support for Selecting and Using AAC Systems

Stage 1: School team identifies need for voice output communication aid.
1. Team identifies situations in which a non-technical system does not address student‟s
communication needs.
2. Team agrees on student‟s representational level (e.g. object, picture, whole word, letter).
3. Team agrees on access method.
4. Seating and positioning concerns for classroom activities are addressed.
5. Time for programming of communication aid is recognized.
6. Necessary support staff members are in place.

For assistance with any of the above steps: SET-BC regional consultants collaborate with
school based teams to support students who are using AAC technologies. The following stages
describe some of the key steps in the process of matching student need to technology,
planning, implementing and following-up on student use of AAC technology. For more
information, contact a SET-BC Regional Centre, or visit the SET-BC website at www.setbc.org.

Steps 1 or 2 - Request AAC consult from district, or services from an agency.

Steps 3 or 4 - Request OT consult from district, or services from an agency.
Steps 5 or 6 - Contact school or district administration.

Stage 2: Team plans for the use of technology.

Team contacts SET-BC District Partner to initiate request for SET-BC service and to discuss
possible equipment loan from SET-BC.
District screening team for assistive technology determines which students will be put
forward for SET-BC services and which students will be served at a district level.
Team may field test the voice output communication aid that they think will match the
student‟s strengths and needs.
School team and SET-BC consultant develop Collaborative Action Plan (CAP), including
strategies for message selection and system implementation.
SET-BC consultant provides equipment, training and support to school team.

Stage 3: Team implements the AAC technology.

School team maintains system, including ongoing programming of messages required for
current student need and classroom activities.
Equipment use is reviewed as part of regular IEP process.

If the AAC technical system doesn’t appear to meet student need

Team reviews relevant items from Stage 1.
Team contacts SET-BC consultant to request support.

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Stage 4: Student moves to new setting.

Prior to any student or staff transition:

Team shares information on technology use in the classroom.
Team describes roles of technical and non-technical systems for the student.
Team provides overlays, technical tips, and training ideas.
It is also useful to provide photos or a video of the student using the VOCA, and a student
information binder.

CAYA Support for Selecting and Using AAC Systems

A person whose speech does not meet their daily needs, and his/her age is within the mandated
age range, can request services from CAYA. The process begins by completing a Request for
Service form (or a Transition form if a recent SET-BC graduate) and submitting this to the CAYA
office in Vancouver. These forms can be downloaded from our website at www.cayabc.org

CAYA provides service in cycles during the year. A letter acknowledging receipt of the request
will be sent out immediately, but service may not be initiated for a few months, as determined by
caseload issues. Client visits and meetings will be initiated by the Speech Language
Pathologist (SLP).

The individualized service delivery process from this point on will be determined by the team
supporting the person who uses AAC. It will vary from person to person, but the components of
assessment, environmental considerations, equipment trial, lite-tech system development,
implementation and follow up will be part of the process.

Clients will be supported in a fairly direct fashion at the beginning of the process and then, as
system expertise increases and the team supporting the individual becomes more independent,
the Client will be placed on “monitor” status and it is expected that he/she will use the system in
as functional a manner as possible. Should major revisions or updates be identified, the team
can contact the SLP for a follow up consultation.

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Including People Who Use AAC

Communication goals should be discussed and documented at the person‟s planning meeting.
After goals are established, the team needs to review a range of strategies that can be used to
support the person using AAC and identify the approaches that are most meaningful. The
following general guidelines may provide some direction for teams when planning strategies for
a person who uses an AAC system.

Structure the physical environment to support communication. Make sure that the person
has consistent access to an appropriate technical or non-technical AAC system. Ensure
proper seating and positioning so the person can access the AAC system independently.

Provide frequent opportunities for communication. All people need opportunities to

communicate their thoughts and ideas in order to learn and develop. Unlike people who
speak, those who use AAC systems may not be able to initiate, get attention, or interrupt
others, even if they are motivated to say something. We need to structure communication
situations with a shared focus of attention, so people have many chances to communicate
and interact. By incorporating communication opportunities in daily routines, the person who
uses AAC will have regular chances to interact.

People with physical disabilities may need extra support in order to get access to
communication partners and to get involved in motivating activities. It is helpful to teach
communication partners how to talk to, understand, and respond to the person using an
AAC system. They can often find creative ways for the person using AAC to participate in
activities.

Expect successful communication from the person who uses AAC. When we have a
conversation with a speaking partner, we expect interaction and responses. We must have
the same expectations for the people who use AAC systems. Expectation is a critical
component of a successful communication partnership. If we expect participation, we
increase the chance that it will happen.

Wait expectantly and provide the person with enough time to communicate. Those who
speak can often carry on conversations, interrupt and interject with great speed. People who
use AAC systems communicate at a much slower rate. We must allow time for
communication messages to be sent and received.

Respond to the person‟s communicative attempts, confirming the intended message or

clarifying meaning if necessary. You may want to use the person‟s AAC system to
participate in conversations, demonstrating how to say specific messages and modeling
appropriate interaction strategies, such as turn taking or asking questions.

Try different problem solving strategies if you do not understand what the person is trying to
communicate. Ask the person to repeat the message, ask if they have another way to say
the same thing, or ask if they can give you a clue or hint. Look for gestures, eye pointing, or
other body movements that might indicate a person or object related to the message. Try to
narrow down the message topic using the “20 questions” approach, starting with broad
topics and gradually working towards more specific topics.

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Provide regular ongoing instruction in the use of the communication system. People need to
be formally taught to use the AAC system and need frequent opportunities to practice using
it in meaningful situations. Set aside time to teach vocabulary, strategies for communication
and interaction, as well as operational skills for any technical AAC systems. Communication
lessons should have clear objectives that build upon previously learned skills. Monitor the
person‟s progress and skill development and make long-term plans for further learning and
growth.

Update the messages in the AAC system regularly to ensure that they meet the person‟s
communication needs and are appropriate for the current environment. Review the AAC
system regularly to ensure that it continues to be the most effective communication tool for
the person.

Ensure ongoing training and support for the person‟s communication partners. Search out
opportunities for professional development in augmentative communication for team
members. Share ideas, discuss communication issues and problem solve with others with
an interest in AAC.

Supporting a person who uses an AAC system requires a long-term commitment from his or
her team. This may be challenging at times and progress may seem very slow. It is therefore
very important for the team to focus on positive developments and recognize successes on
the part of the person and the team. The examples of positive statements in the following
table (Prentke Romich, 2000) may help to refocus teams when the use of a technical (or
non-technical) communication system seems to be a problem.

We are leaving the device behind We are definitely taking the device along
because… with us because…
There‟s a vague chance it might get rained You are a grown-up and grown-ups talk for
on. themselves.
We are going to eat and you might spill on I am not your mother and I won‟t talk for you.
it.
We are going to get a drink and you might You need to order for yourself at the
spill or drool on it. restaurant.
It might get lost or stolen. People treat you with more respect when you
talk for yourself.
It might get broken on the van. It was made to be carried around and can be
fixed if something goes wrong.
It‟s too much trouble to carry around. You are going to meet new people who you
can talk to by yourself.
The battery might run down if we take it. You will need it to get what you want.
Without it, you are going to do without.
We don‟t want you talking to strangers. We don‟t know what you might need to say,
but we know you will have chances to talk.
Someone might steal it. People treat you the way you expect to be
treated. And you expect to be treated as
well as a person who can communicate.
We might leave it behind. It‟s too important to be left behind.
I know what you need to say and I can talk I can‟t read your mind.
for you.

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In the school system, if a student is using an AAC system, he or she will most likely also have
an Individualized Education Plan (IEP). It is important that the AAC system be acknowledged in
the IEP, but it should not be a goal in the IEP. Rather, it should be listed as a strategy or
technique that a student will use to complete educational goals.

Once a person leaves the school system, a Community Care Plan will be developed. Major
revisions to the AAC system may need to take place as the person who uses AAC participates
in this major life transition. The AAC system should be acknowledged in the Care Plan in a
similar fashion as it is in the IEP. It is a strategy or technique that a person will use to achieve
their life goals.

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 Supporting People who use AAC Strategies

Assessment
In situations where a person is unable to communicate effectively with family and friends,
alternate ways of interacting and participating need to be investigated. The process of
investigation or assessment may include formal and informal components.

In order to make effective decisions about AAC systems and devices, we need to gather
relevant information. The following general questions may help address this process:
What do we want to know and learn from this assessment?
What information do we need to gather?
What is the best method of gathering this information?
How are we going to document the relevant information and where will it be retained?

Identify needs
The team should keep the person‟s needs at the forefront of all discussion and assessments, by
focusing on the following three questions (Beukelman et al, 1985):
What are the person‟s communication needs?
What needs are met through current communication techniques?
What are the systematic AAC interventions that will reduce unmet communication needs?

Describe current system

A good starting place is with a description of the person‟s current means of communication,
including successful strategies, tools and communication methods. Consider the following
points in your assessment:
Determine the effectiveness of the current communication in terms of the person‟s
interaction and participation.
Collect information about the person‟s communication environments, routines and
communication opportunities.
Identify partners with whom he or she communicates most effectively.
Assess the person‟s language and literacy abilities as these will have an impact on the type
of symbol set to be selected.
Find out about the person‟s interests, likes and dislikes, and preferences as these may
determine the success or failure of implementation.
Assess the person‟s physical capabilities related to movement, seating and positioning,
fatigue, vision, and auditory abilities. This is critical when determining the person‟s method
of access for the selected AAC system.

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Evaluation tools
Currently, there are no standardized assessment tools on the market that have been
determined to be valid and reliable when assessing the communication skills of people who use
AAC. There are, however, several products that have been created to help teams make
decisions about AAC systems.

Some commercially available assessment protocols are: Functional Communication Profile-

Revised (Kleinman), Communication Matrix (Rowland) and TASP (Bruno). Others are
commercially available and have been adapted for alternative access (contact your SET-BC or
CAYA Consultant): PPVT, TACL and CELF. And other informal evaluations are available by
contacting the authors: CAAP-Communication Assessment & Action Plan (CAYA), Minspeak
Assessment Protocol (VanTatenhove) and AAC Language Sampling Procedure (Burkhart).

Ongoing team process

Assessment is not the job of any single individual. It requires team collaboration and input from
the person who uses AAC and their family. There are many resources available to assist in the
assessment process. For a student, look to resources available within your school, district,
provincial resource programs and external agencies. For adults, look to CAYA and ATSS.
There are many AAC texts and web sites which can also provide you with background
information. (For suggestions, see appendices A and C at the end of this guide.)

A major component of AAC assessment may include extended assessment of several

strategies or technical devices. Extended trial with specific devices can allow an opportunity,
within a specified time frame, for the team to acquire key information for decision making. As
with the other aspects of assessment, clear documentation of extended assessment information
is essential. This provides the team with baseline information for ongoing evaluation purposes.

Assessment is not over once the team has identified an appropriate AAC system for a person.
Keep in mind that an AAC system or device will need to be updated and reassessed as the
person or their environment changes. Vocabulary within a system will also need to be revised
on an ongoing basis. Working with the person who uses the AAC system to implement these
changes is essential.

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System Components
An AAC system is comprised of the following parts:

the means to represent (symbols)

the means to select (access)
the means to transmit (lite-tech system/electronic device)

Symbol sets

Determining a symbol set that will be most appropriate for a person at any given time is a critical
component of the assessment. It is most easily done in a team format, where all parties
concerned can contribute their observations and knowledge. The symbol set that is most
appropriate for a person might change as the person, the environment, the communication
partners, and the field of AAC changes and progresses.

The means to represent requires the selection of a symbol set for use with the AAC system.
There are many types of symbol sets available for people who require them. Symbols sets are
usually categorized as ”unaided”, which use movement or sounds to represent meaning (e.g.
gestures or sign language) and “aided” (meaning that there is a board, or book, or device
associated with them).

People using AAC may incorporate a variety of aided and unaided symbols in their personal
communication system. However, the selection of an aided symbol set is of major significance.
Aided symbol sets are described in more detail on page 33. Symbol sets may be combined
using particular system rules or logic to allow the generation of novel utterances. Minspeak is an
example of a symbol set which is intentionally abstract so that the symbols can be used to
represent a wide variety of concepts.

Some issues which need to be considered in the selection of particular symbol sets are as
follows:
How transparent is the symbol?
How complex?
Does it allow for concrete as well as abstract concepts?
What is the degree of ambiguity?
How many messages does the symbol set allow?
What is the efficiency of communication allowed by the symbol set?

Alternate Access

The term “access method” describes how the person will select the messages he or she wishes
to communicate. Determining the access method is a major component of the assessment and
information gathering process. The person‟s motor abilities and physical limitations, together
with information on fatigue levels, vision and hearing, will help determine the preferred method
of access. It is essential that an occupational therapist be consulted when considering access.

The following access options may be considered:

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Direct selection
The person points to, or directly touches, the message or symbol representing the message.
Direct selection is a preferred access method, because it is relatively simple and quick.

Eye pointing
This is also a form of direct selection. An eye-gaze board, or “e-tran”, can assist with eye
pointing. The person gazes at symbols that are attached to a transparent frame in order to make
a selection. The communication partner “reads” the eye-gaze from the other side of the frame.

An e-tran provides a low-tech method of communication for some people.

Assisted direct selection

The person may use a tool such as a joystick, trackball or light pointer for assisted direct
selection. A splint created to support a finger is another example of assisted direct selection, as
is Morse code when considering software.

Scanning

Partner assisted scanning

This access method is useful for people with both motor and visual challenges. Using a non-
technical system, the communication partner reads out and points to each choice in a
predetermined, consistent pattern. The person indicates when the desired selection has
been identified. Linda Burkhart and Gayle Poole have created resources to support
learning this access method.

Visual scanning (for electronic communication aids)

Message choices are illuminated electronically, one at a time, by a moving cursor. The
person selects the desired item by activating a switch when the choice is illuminated. This
access method may be appropriate for the person with motor control problems, giving
him/her the ability to accurately select a message from many choices. Scanning can be
slow, however, as the person must wait for the cursor to move to his/her selection.

Auditory scanning
When using auditory scanning with electronic communication aids, messages are quietly
read out upon activation of a switch. The person presses the switch again when the desired
message is heard, and the message is repeated at a higher volume (Locke and Levin,
1999).

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Systems and devices

Individual AAC systems are often comprised of both non-technical and technical components.
Each person who has an electronic system must have a non-technical system for use when the
electronic system is neither available nor appropriate. As an example, it can be dangerous to
use battery operated or electronic technology in the rain or near a swimming pool! A non-
technical eye gaze system can often be quicker and more efficient to use with familiar
communication partners than would a technical device.

Electronic devices are also divided into two categories; dedicated and integrated systems.
Dedicated devices are used for communication purposes only while integrated systems are
computers that run communication software and also function as regular computers. There are
pros and cons to both types of devices and these must be acknowledged and considered before
a decision is made.

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Transitions
Growing up is a continuum of new experiences and new learning. Children move naturally from
one set of expectations to another as they grow from infancy through the stages of childhood.
There are transitions from home to school, from grade to grade, between and within extra-
curricular pursuits, and with friends. A milestone transition takes place when young people
graduate from high school.

School to Adulthood

High school graduation is only one element of the transition from childhood to adulthood. In the
years between ages 17 to 25, most young people will move from pediatric medical care to an
adult medical plan, from educational to vocational activities, from their parents‟ homes to more
independent living arrangements, and from family-based financial provision to personal income
planning. In terms of medical services, there is a qualitative as well as quantitative change in
the care provided to adults, with fewer services available to adults and much more personal
responsibility for arranging and managing care and equipment needs.

For those young people who will not transition from high school to post-secondary education or
to competitive employment, a daily familiar schedule of activities must be replaced. Colleges
offer some programming for young people with developmental disabilities, and the Employment
Program for Persons with Disabilities (EPPD) provides vocational training. These students
should apply for this program or for appropriate assessment by the second term of grade
twelve. If the young person is a candidate for Community Living BC, that organization offers
some day programs and also some residential options.

Young people who do not qualify for CLBC but who require assistance with personal care will
look to their local health units for long-term care hours or for residential care. Those young
people who do not require assistance with personal care but who have disabilities that interfere
with the ability to compete for paid employment will look for housing by applying at co-ops
organized by the Vancouver Resource Society or the BC Independent Living Society. Finally,
young people will move towards financial independence when, at age seventeen-and-a-half,
they start the application process for income assistance through Persons With Disabilities
(PWD): a financial program available to children who have been on the At Home program.

Discovering Adult Communication

Students in grade twelve who use AAC or who are candidates for the use of AAC should be
referred to CAYA. All of the aforementioned transitions will affect the young person‟s
communication needs upon graduation from high school. When communication environments
change, the vocabulary on the VOCA will also need to change. Furthermore, these young
people will have a greater need to be independent in the use of the equipment so that they can
direct their own care as well as instruct others how to communicate with them and how to care
for the equipment. They will need to cope with unfamiliar communication partners. They also
need to learn to deal with frequently changing communication partners, for example, with casual
staff at care facilities. The new environmental factors should be considered when choosing a
communication system and when setting goals for both younger and older students.

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Self-Advocacy and Empowerment

Having the ability to control one‟s environment is essential to well-being. Teaching a person to
create what he or she needs goes beyond the activities of daily living. It extends to issues such
as assertiveness, how to make decisions for one‟s overall plan for living, and setting career and
lifestyle goals.

Safety and Rights

Although we certainly wish that this were not the case, people who have disabilities can be in a
vulnerable position. This can be compounded if individuals are not able to talk about what they
fear may happen or what in fact has happened in their situation. This vulnerability can be
reduced by teaching people who use AAC how to create a safe environment for themselves.
We can also teach them about their legal rights and how to communicate when their rights have
been violated.

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Section 2: AAC Intervention

Intervention Models, Approaches and Techniques

Teaching people how to use AAC as a method for communication is a long process. There are
several models, approaches and techniques that can help teams teach, set long term goals and
measure outcomes. It is important to note that these are not mutually exclusive, nor are they
either-or approaches. Rather, they can be used to set goals for people that are both relevant
and possible within the environment.

1. Continuum of Communicative Independence

This model was created by Pat Dowden at the University of Washington. Becoming an
independent communicator who can “communicate anything on any topic to anyone” is the goal.
On the way to achieving this goal there are two major milestones, combining to form three
stages in total.

An “Emerging” communicator is an individual who does not yet have any reliable means of
symbolic communication, although he/she typically has non-symbolic communication (Dowden,
1999). This communication, for example using gestures and facial expressions, can be very
useful with highly familiar partners, but it tends to be limited to the "here and now" or rely heavily
on the partner's shared knowledge.

A "Context-Dependent" communicator has symbolic communication that is reliable, but it is

limited to particular contexts or partners. Context-dependent communication is more effective
than emerging communication because it is not limited to the "here and now" or shared
knowledge by the partner.

An “Independent” communicator has the ability to communicate with both familiar and unfamiliar
partners about any topic in any context (Dowden 1999). "Independent communication" does not
mean that the individual does not rely on technology or assistance from people in the
environment.

Information retrieved from the world wide web, http://depts.washington.edu/augcomm/

2. Participation

The Participation Model (Beukelman and Mirenda, 1998) provides an overall framework of
considerations associated with enabling people who use AAC to communicate as their peers
do. There are access and opportunity issues within society that must be addressed for people
to participate fully in their lives.

Within general education settings, there are four areas where participation patterns can be
analyzed and measured: integration (physical, academic and social), academic participation
(competitive, active, involved, none), social participation (competitive, active, involved, none)
and Independence (full, selective or none).

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3. Communicative Competence

Communicative competence (Light and Binger, 1998) for people who use AAC goes beyond
simple language skills. These competencies can be divided into four main areas (Light 1989):

Operational Competence
The first skill, operational competence, refers to the ability of the person to operate their AAC
system. It is analogous to actually being able to speak. It includes access to the device, ability to
program vocabulary (either assisted or not), charging the device and so forth.

Linguistic Competence
The second skill, linguistic competence, refers to the ability to use vocabulary and grammar.
Ideally, a person who uses AAC would have good linguistic skills. These skills may be more
difficult to acquire though, due to access issues, practice, and the age at which they are often
learned.

Social Competence
The third skill, social competence, refers to the ability to use social rules such as when it is
appropriate to speak, appropriate topics and levels of formality, detail and so forth. A few
examples of social competence are turn-taking and asking partner-focused questions.

Strategic Competence
The fourth skill, strategic competence, refers to the ability of a person who uses AAC to
approach their interactions in a more planned, strategic way. This area of communication is
much more of a focus for individuals who use AAC than for typical communicators. Strategy
comes in many areas, such as improving speed while still presenting enough information, and in
preventing and repairing breakdowns. Communication breakdowns when using an AAC system
are often more disruptive and challenging than in typical conversations. One example of a
communication strategy that is unique to people who use AAC is an introduction strategy.

Use/Model/Teach
One adaptation of the Communicative Competence model is the Use/Model/Teach approach
referred to in the Dynamic Display Section of the PowerPoint presentation accompanying this
guide. To become a competent AAC user, a person would need the opportunity to USE a
communication device, having opportunities to develop operational competence, linguistic
competence, social competence and strategic competence. It is equally as important for a user,
however, to benefit from the experience of another person MODELING how to use a
communication device. Sarah Blackstone considers modeling “an essential” instructional
strategy because it
 Provides language models for beginning communicators to emulate
 Sensitizes facilitators (clinicians, family members and teachers) to difficulties inherent in
using AAC approaches as forms of expression
 Requires that facilitators become competent users of AAC strategies and technologies, and,
thus ensures some accountability for those who teach children to use AAC.
 Confirms that adults and peers consider speech generating devices (SGD), manual signs
and communication displays, etc. valuable modes of communication.”
(Blackstone, 2006)
In addition to having opportunities to USE a communication device and to experience
MODELING, some skills will need to be taught. Users may need to be taught specific
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vocabulary, specific features of the device and other supporting skills. Millman recommends
TEACHING skills that support communication and active participation such as active listening,
maintaining a topic, and repairing a communication breakdown. (Millman, 2006)

4. Social Networks

Blackstone and Berg (2003) use the principles of functional goal setting and person centred
planning to create social network inventories of an individual‟s communication partners and
preferred modes of communication. This provides a picture of the individual‟s communicative
competence across a variety of partners and situations. Examination of social network
inventories over time may be useful as an additional tool for gathering outcome measurement
information.

5. Development

Although not a formally researched approach, many teams find this way of thinking useful for
setting goals, especially in schools. The basic concept is that learning to communicate using an
AAC method is not fundamentally different from learning to communicate using speech. In
essence, all of the developmental stages of language learning still apply. There are obvious
differences, in that the modality is different, and developmental stages can happen at any age,
and often in varying order, depending on when a person had access to what form of
communication. These stages can also be considered independent of cognitive level, in that
even a cognitively typical child often has to go through these stages when first presented with
voice output.

For example, let‟s look at the vocal play stage. Often when children are given an AAC device,
they are eager to try all of the messages (In fact, this is what adults often do too when they are
looking at a device). They often find a favorite message, and play it over and over again.
Usually, a clinician‟s instinct is to allow them to play for an hour or two, and then move quickly to
discourage „unintentional hits‟. This can even be translated into taking the device away if the
child is disruptive. Imagine covering up an infant‟s mouth if he disturbs a movie theatre by
making raspberry sounds!

Let‟s imagine what we would typically do with a child at that stage. We would take him out of the
movie theatre, and then have a fabulous afternoon burbling at one another (and thus teaching
turn-taking). This also applies to the person who is using a voice output device. We could work
with them in an appropriate environment, taking turns selecting messages, and giggling when
we got a great turn taking rhythm going.

In summary, although language development in children who are using AAC is not exactly the
same as typical children, it can be very helpful to create analogies to typical language
development. Those analogies can help guide us in our intervention.

6. Routines/Choice Making/Matrices

The typical child first learns language based on what is familiar and routine in his or her
environment. Routines, by definition, are predictable and have a high frequency of occurrence.
They create the structure onto which we can hang language labels and thereby map out our
world. Adults rely on routines every day; they provide structure, consistency and reliability in
our lives.

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Creating opportunities to make choices must also be one of the strategies of teaching
communication. Choice making can easily be built into many activities throughout a day, in the
classroom or the community. Choices can be offered around how things are done, when they
are done, with whom, or with what materials. Through choices, the person then has some
degree of control over his or her life with all its inherent rewards, risks and consequences.

Here is an example of how AAC activities can be schedules into a weekly routine. “Debbie” is a
composite person and this is her weekly schedule:

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Library binder
Swimming Laminated
page on a
flutter
board
Mall device
Walks device device device
TV/movies device device device device device device device
Meals Placemat Placemat Placemat Placemat Placemat Placemat Placemat
with with with symbols with with with with
symbols symbols around symbols symbols symbols symbols
around around border around around around around
border border border border border border
Washroom Activity Activity Activity Activity Activity Activity Activity
overlays overlays overlays on overlays on overlays overlays overlays
on wall on wall wall wall on wall on wall on wall
Groceries device
Laundry device
Dishes device device device device device device device
Dances device
Social device device device device device device device
Chat

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7. Second Language Learning

Introducing a new AAC system can present quite a challenge. One paradigm that has been
useful for many people is that of teaching a second language. For example, a great deal of
exposure to a language is essential before a person can begin to speak a second language.
Just as it is difficult to learn a second language with two hours of instruction a week, it is difficult
to learn a new AAC system in that amount of time. This is especially true for complicated
systems such as dynamic display or semantic compaction systems (see section on VOCAs).

Creating that kind of extended exposure can be much more challenging for people using AAC,
as often they are the only one learning that „language‟. There are things that can be done
though, such as: creating multi-modal language environments, providing books with symbol
translation, providing curriculum and learning materials translated into those symbols, and using
the system itself to model. Just as with a second language, once a certain level of proficiency is
achieved, practice (and a great deal of it) is required. This can occur naturally with people who
are using AAC, as they will presumably be using this system in many of their daily
communication interactions.

Another example is to look at the level of difference between one system and another. For
example, consider moving from a four message device to an eight message device, versus
moving from a communication book to a Minspeak device. Two languages may be as close as
Italian and Spanish (which use the same sound system and alphabet, and share much
vocabulary), or as different as Finnish and Mandarin (which have different sound systems,
grammar, alphabets and share almost no vocabulary). Acknowledging the level of difference
between the systems can help us set timelines and create reasonable goals.

8. Prompting/Fading

Many teaching models suggest that the learner should initially be provided with verbal and or
gestural cues to elicit a desired response or behavior. These cues or prompts are faded over
time until the learner can produce the behavior independently. Unfortunately, for many
communicators, this teaching strategy can lead them to become "prompt dependent". That is,
the learner does not become an initiator of communication and he does not produce
communicative behaviors until a cue is presented (e.g., What do you want?, Push the switch,
etc.).

One solution to this problem is to use a least-to-most prompting strategy to elicit communicative
behaviors. This training strategy suggests that initially, no cues are provided to the
communicator. Cues are then added as needed, beginning with the least intrusive cues.

Information retrieved from the internet,

http://aac.unl.edu/intervention/Least_to_Most_Prompting.html

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9. System for Augmenting Language (SAL)/Aided Language Stimulation/ Augmented

Input

A key component of the System for Augmenting Language (Romski and Sevcik, 1996) is the
provision of human models to show how to use augmentative communication. The facilitator
should demonstrate how to communicate using the technical or non-technical system. It is this
human modeling that has a direct impact on how successful a person becomes. It is sometimes
known as Aided Language Stimulation and Augmented Input.

The partner‟s role in interactions includes using the AAC system:

Communicative partners were encouraged to integrate the use of the devices

into their own spoken communications by employing what we have characterized
as augmented input. In the example, “Tommy, let’s go OUTSIDE and ride your
BIKE”, “outside” and “bike” were touched on the device, produced by the speech
synthesizer, and spoken by the partner. This communicative model permitted
each family or teacher to incorporate the device’s use more easily into individual
communicative interactions. (Romski & Sevcik, 1996, p. 66)

This overlay can be

used for both
facilitator modeling
and student
communication while
in sandbox play
(Goossens, Crain and
Elder, 1994, p. 128).

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10. Partner Assisted Scanning

Partner assisted scanning is a technique utilized to support people to use a paper based AAC
system when they can‟t access it independently. The communication partner reads through a
predetermined pattern of messages/words/letters and the person using the system indicates
when the correct item has been spoken. This gives the person using the system predictability
and confidence that they know what is coming. When a predetermined pattern is not used,
communication partners can differ in the questions that they ask and this is confusing for the
person who is using the system.

11. PODD: Pragmatic Organization Dynamic Displays

The PODD approach was created by Gayle Porter (2007) and has been recommended by a
number of clinicians including Linda Burkhart (2006). It is an AAC approach that organizes
vocabulary according to communicative functions such as requesting, commenting, rejecting,
etc. The approach uses partner assisted scanning to develop receptive language skills, in
addition to expressive language skills. In contrast, other partner assisted scanning approaches
focus primarily on giving users an expressive means of communication.

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Message Selection
The messages in any AAC system should be age and gender appropriate as well as reflective
of the person‟s personal interests and cultural background. They will need to be continually
revised and updated as the communication needs and abilities of the person change. This will
be an ongoing process.

Factors Influencing Vocabulary Selection

General Considerations

Various AAC strategies are used for various purposes. The messages on a non-technical
system for one-to-one discussions with familiar partners may be different from the messages on
a voice output communication aid used in making formal presentations and answering
questions. The physical system may vary depending on the situation. The same person may
use gestures and vocalizations with family members, a palmtop device when communicating
with peers and communication software when composing and sending email.

The messages must be things that the person is motivated to communicate about. The team
should include messages of interest to the person, as well as the current, popular phrases of the
day. These phrases will have to be changed when they are no longer relevant.

When planning for specific activities, like taking out a library book, consider what questions and
comments peers frequently say, and then provide generic messages that can be used during
this activity.

Vocabulary that the person already communicates appropriately using another conventional
mode may not be needed. For example, the person who indicates “yes” and “no” with head
movements may not need these symbols on an AAC display.

Motivating symbols use interactive vocabulary and social expressions.

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Message functions: participation and communication

To facilitate the team‟s selection of vocabulary and implementation strategies, it may be useful
to conceptually divide the uses of VOCAs into participation and communication. Single message
devices would be almost exclusively used as participation devices, while multiple message
devices may provide a combination of participation and communication functions.

Participation functions use messages that signal that the person is an active participant in the
activity; that he/she is part of the group. The particular form of participation may vary:
“Have we fed the cat yet?” as the family is gathering to eat dinner
“I would like to withdraw…” at the appropriate time when taken to the bank
Making social comments such as “way to go”, “far out” or “right on”
“How was your weekend” at coffee time

With single message devices, even when the message uses communicative words, it has
usually been programmed by someone else who is making the communicative decisions. The
task for the person is to participate in that chosen activity. For people who use nonverbal
communication strategies, participating vocally (via technology) can be an important skill to
develop.

Multiple message devices can and should serve both functions. They provide the person with
the opportunity to make independent decisions about what he/she will say. This can be in the
form of a display of possible selections or the means to program totally novel and complex
ideas. At the same time, the person will still be able to participate in prescribed social
behaviours, or signal that he/she is still involved in an ongoing dialogue, e.g. “ah hah”, or “right”.

Vocabulary issues

Vocabulary items are most often divided into two types; core and supplemental (or fringe). Core
vocabulary items are common words that can be used in more than one setting, such as “more”,
“here”, “look”, “it”, “wow”, etc. This allows for flexibility. Supplemental vocabulary items are
words that are used only in one setting but are critical in that setting, such as “Santa Claus”,
“Christmas tree”, “tinsel”, “eggnog”, “Rudolph”, etc.

Using mostly supplemental vocabulary in AAC systems means that for every communication
environment, new items must be learned. This can take energy that could be used in the
interaction. It is desirable to provide a balance between core and supplemental vocabulary
items that meet the needs of the person, so he/she can communicate most easily in many
environments. Studies of typically speaking young children have shown that they use mainly
core vocabulary items in their communication messages and that adults provide the
supplemental items. (Marvin et al, 1994).

Visual Scene Displays

Visual scene displays were developed as a way to support the communication of people with
cognitive-linguistic disabilities, including people with aphasia. A visual scene is a photograph of
a scene with high personal relevance, to which messages can be attached. Examples would be
pictures of individuals or families in their backyard, or a picture of the user‟s living room. Any
number of written or recorded messages, hot spots, pop-ups, or pages can be accessed from
each photograph. The visual scenes are displayed together on a main page and the user can

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navigate from a particular photograph or visual scene to another page with more photographs
with a similar theme.

Because visual scene displays represent people, objects, activities and events in naturally
occurring backgrounds, they provide contextual support to the user. The communication
partner‟s interaction is also supported because of the additional information contained in the
visual scene, as opposed to a more generic picture. Particular events from the user‟s life may
be captured and form the foundation for supported conversation. For users with cognitive-
linguistic disabilities, the visual scenes also assist navigation from page to page more effectively
than do category symbols.

Visual scenes may be loaded onto a device or they may be formatted into a low tech display.
Weissling and Beukelman have created Low Tech Visual Scene Templates which are available
at no cost from their website http://aac.unl.edu and www.aac-rerc.com.

Types of Messages

Letters, words, phrases and sentences

Communication can be faster when a whole phrase is presented above a symbol, however, this
also limits the generation of new thoughts. Whole phrases may be appropriate for the beginning
communicator, but the team should consider adding single words as soon as the person is able
to recognize, use and combine them. Phrases and single words can be used within a single
display.

Letters may be used if the person knows initial letters of words. Even if he/she can‟t spell an
entire word, pointing to initial letters of words gives the partner a good clue to the message if the
context is known. Grammatical markers can also be considered, if appropriate.

Facilitation Messages

These messages help clarify and repair communication. Examples include “not on this board”,
“no symbol”, “please repeat”, “I made a mistake”, “I don‟t understand”, “I‟ll spell the first letter.
Please guess the rest”, “almost” “you‟ve misunderstood” and “finished”. (Johnson, 1995)

Examples of facilitation messages

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Messages and symbols for self advocacy

The ability to independently manage the communication system is a skill which people who use
AAC need to develop. This can be assisted by including symbols/messages for appropriate
functions regarding the care, maintenance and programming of the system. Examples may
include: the ability to increase/decrease volume depending on the situation, the ability to ask for
the battery to be charged, or the ability to request additional symbols.

Barbara Collier has created a group of page sets for DynaVox devices called “Communicate 4”
which supports people who use AAC to advocate for themselves in all aspects of their lives.

Examples of Symbol Sets

There are hundreds of symbol sets to consider when determining an AAC system for a person.
It can be confusing. Here are some defining characteristics of the more popular symbol sets
used in BC:

Picture Communication Symbols (PCS)

was developed at Mayer-Johnson, Inc.

was intended to be a fairly transparent symbol set that did not require much instruction
Boardmaker:
o is an extremely popular software program that provides an electronic library or catalogue
of the PCS symbol set
o allows you to customize symbols and add in other graphics
o is not the name of the symbol set

Picture Exchange Communication System (PECS)

is a method of communication of handing a symbol to another person to transmit a message

can use any symbol that works for your student
promotes the notion that the communication partner is an important part of the interaction
was created by Frost and Bundy (1994) for use by children with a diagnosis of autism
has a very structured teaching protocol and recording method.
is not a symbol set

DynaSyms

is a set of symbols created by Faith Carlson (1991) for DynaVox Systems

are similar to PCS
are preloaded on the DynaVox family of communication devices.

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Tangible Symbols

are three dimensional symbols used to represent various concepts

are often a beginning step on the path to more conventional AAC systems
were created by Rowland and Schweigart (2000) for use with people who have severe,
multiple disabilities

Minspeak

is a symbol set used with the linguistic system of semantic compaction

is found on specific devices produced by Prentke Romich Company
is based on the concept that a finite group of symbols can represent more than one
meaning, depending on the order in which they are used.
requires intensive teaching at the beginning, but after that period it allows for generative
language to be produced

Orthography

is standard written language

is an extremely valuable symbol set for a student who is non-speaking
allows individuals who are non-speaking to communicate their original thoughts and
feelings by spelling

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Literacy & AAC

The non-speaking person who can spell has the power to create all of his/her own messages,
without having to rely on someone else to create symbol message displays. Even the person
who has beginning spelling skills can use strategies to enhance communication; for example,
pointing to an initial letter to provide “clues” about what he/she would like to say.

Emergent Literacy

Emergent literacy activities can be conducted with everybody. Koppenhaver et al

(1993) have adapted a model from Teal and Sulzby that includes communication, reading,
writing and listening as basic components of literacy. All components of the model are
interrelated and learning in one area will positively affect the others.

Communicating

Reading Writing

Listening

Communicating, reading, listening, writing

Based on this philosophy, nobody is too cognitively or physically challenged to participate in

literacy activities in some fashion. Linda Burkhart, Patti King-DeBaun, Karen Erickson and
Caroline Musselwhite are some authors who have published in this area.

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Key Factors in Learning to Read

Learning to read follows a similar process for both speaking and non-speaking students.
Musselwhite and King-DeBaun (1997) describe a number of key factors that influence the
development of reading skills.

1. Expectations of learning
Students with severe speech and physical impairments often do not have high expectations
placed on them for educational performance. Care of physical needs is very time consuming
and a necessity, however, expectations for these students in the area of literacy achievement
are vital for success.

2. Opportunities for practice

Tied to expectations are opportunities for practice. Many studies have determined that students
with severe speech and physical impairments have greatly reduced opportunities for practice in
the classroom.

3. Attention to meaning rather than form

Literacy activities are most powerful when they are meaningful and serve a purpose.

4. Models of reading: being surrounded by reading and readers

The immersion approach of providing models of purposeful reading in a frequent, consistent and
high profile manner has a positive influence in the learning of literacy skills by students with
severe speech and physical impairments.

5. Motivation
Motivation is a powerful force. Literacy materials should be focused around materials that
students can connect with and enjoy.

6. Success
In order for students to hold a positive self-image and be motivated to improve their literacy
skills, they must experience success, and experience it often.

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Balanced Literacy Instruction

Balanced literacy instruction (Erickson, 1999) is a model that allows for the inclusion of students
with different levels of literacy skills. This balance of clear and consistent goals across
instructional strategies and contexts is based on the Four Blocks system developed by
Cunningham and Allington (1999).

Not all students will learn to read and write, but all will benefit from opportunities
to interact around print-based activities. Long before students develop
conventional literacy skills, they can use the alphabet and knowledge of print to
communicate in sophisticated ways. (Erickson, 1999)

1. Guided reading
The purposes of this block are to expose children to a wide range of literature, teach
comprehension, and teach children how to read with books that become increasingly harder.

2. Self-selected reading
The self-selected reading block allows students to choose what they want to read. The teacher
selects books for the classroom library on themes they are studying, easy and hard library
books, old favourites, predictable books, etc.

3. Writing
The writing block gives students the opportunity to “write for a purpose” and is carried out in
"writers‟ workshop" fashion. Students have the opportunity to brainstorm, plan, draft, revise and
publish their writing.

4. Working with words

In the working with words block, children learn to read and spell high-frequency words and learn
the patterns which allow them to decode and spell words.

The SET-BC website (www.setbc.org) has further information on strategies for including
students who use AAC in each of the four block activities.

The Four Block strategies are being used with success with adults who use AAC and wish to
learn how to read. For more information, contact CAYA staff.

Using an AAC System as a Tool for Literacy

Over the last few years, advances in technology have led to improved interfaces between high-
end voice output communication aids and computers. Integrated systems allow for an
opportunity to use both speaking and writing software. These types of connections can be an
excellent tool for both linguistic and literacy skill building. The proliferation of email and internet
messaging provides a useful and motivating opportunity to utilize the written component of
communication. The current popularity of bulletin boards and websites such as Facebook
allows for the written messages to be constructed in an environment that is not time dependent
and begins to level the playing field for those who use AAC strategies.

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Using an AAC system to operate a computer allows the person to write using standard or
assistive word processing software and, if required, their individualized method of access. By
sending whole words or phrases, the person using the device can concentrate less on the
physical task of typing letter by letter, and more on the expression of ideas. This increase in
efficiency can lead to increased output, decreased fatigue and frustration, and improved literacy
skills.

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AAC Outcomes
Outcome measurement, or evidence based practice, provides information on the effectiveness of
AAC intervention and a rationale for all decisions about AAC intervention. It requires both a
qualitative and quantitative component and data can be gathered and analyzed using a variety of
different approaches. All data collection needs to begin with baseline information.

Collecting Data

Language Samples

Growth in communication skills can be measured through language samples. AAC samples must
include multiple systems. For example, growth could include:
ability to persist in relaying a message by trying different systems and approaches until intent is
understood
increased length of utterances, consisting of signs, voice and picture symbols
increased spontaneous utterances in comparison to cued or imitative responses

The following form can be used to collect language samples of people who use AAC
(Burkhart, 1993).

Language Sample of Expressive Utterances

Name: __________________ Date: ____________ Recorder:___________________

Spontaneous

Intelligible?
Responses

V = voice

Utterance
G = gesture
Imitation

length
Time S = sign language
Other
Cued

VO = voice output
P = picture / symbol (manual system)

S R I C ? ________ ________ ________ ________ Y

VGSVOP VGSVOP VGSVOP VGSVOP N

S R I C ? ________ ________ ________ ________ Y

VGSVOP VGSVOP VGSVOP VGSVOP N

S R I C ? ________ ________ ________ ________ Y

VGSVOP VGSVOP VGSVOP VGSVOP N

S R I C ? ________ ________ ________ ________ Y

VGSVOP VGSVOP VGSVOP VGSVOP N

S R I C ? ________ ________ ________ ________ Y

VGSVOP VGSVOP VGSVOP VGSVOP N

Several communication devices have built in monitors or software to collect quantitative language
sample information. The Language Activity Monitor (Romich & Hill 1999; Hill & Romich 2002) and

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software applications such as the Augmentative Communication Quantitative Analysis (ACQUA)

(Lesher, Rinkus, Moulton, & Higginbotham, 2000) are two such tools. DynaVox has a feature in its
system that counts the number of times a button was activated.

Questionnaires

One way to measure outcomes and hopefully document progress is through the use of questionnaires.
In the last ten years or so, several have been created and are available. Research is ongoing.

Talking Mats
Talking Mats are a tool designed to assist people with disabilities to understand concepts related to
their lifestyle and care. These can be quite abstract concepts and this framework can help to explain
the options and consequences. The original mats, created in 1998 by Joan Murphy at the University of
Stirling in Scotland, have been used in the UK and abroad with people who have acquired and
congenital disabilities. On the mats are symbols representing 3 areas; the topic being discussed, the
options available related to the topic and the visual scale (ie. yes/no/maybe or thumbs up/thumbs
down). Recent research has proved that this process improves the quality and quantity of information
gained and discussed.

Framing a Future
Framing a Future is a self-discovery survey that supports students and teams to plan for life after
school. The questionnaire is divided into seven major life categories: community membership, control
of personal health and welfare, pursuit of lifelong learning, developing talents and interests, creating
healthy relationships, self-reliance, and developing a personal sense of spirituality. After the survey is
completed the student and team identify priorities, complete a planning worksheet and develop annual
goals for the coming year.

“Framing a Future is a tool developed to assist students and their families in creating a vision of the
future so they can begin the transition planning process. Supporting transition from school to the
adult world is critical to future success. Successful adults are able to direct their own lives, speak
up for their own rights, initiate making their own goals, take responsibility, cope with the
consequences of their own decisions and obtain a desired level of independence.

While the focus of preparing students for transition has logically been placed on providing work
experience and training, we know that many other areas of life need to be addressed. Students
with disabilities need to explore their own interests and preferences, understand some of the

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challenges they may face, and be better prepared to advocate for their own interests.” (King,
Unger, Tooney, 2005)

Quality of Life Profile

At the University of Toronto, staff at the Quality of Life Research Unit in the Department of Occupational
Therapy has created profiles to assess the quality of life for adolescents, adults and seniors. Several
versions of the profile are available for purchase and include versions for people with sensory and
physical disabilities and developmental disabilities.

There are three main domains that are measured by this instrument: being, belonging and becoming.
„Being‟ looks at who the person is as an individual and considers the areas of physical, psychological
and spiritual well-being. „Belonging‟ looks at how a person fits into their environments and with other
people and considers the areas of social, community and ecological belonging. „Becoming‟ looks at
how the person achieves their goals and considers the areas of practical, leisure and growth domains.

Goal Attainment Scaling

This is a procedure whereby a person works with their team in order to identify lifestyle goals. The
goals are then placed into a format that allows for them to be measured in a systematic fashion. This
individualized scale allows for five possible outcomes for each goal: much more than expected (+2),
more than expected (+1), most likely outcome (0), less than expected (-1) and much less than expected
(-2). The expected outcomes are individualized for each person based on their current abilities.
Training is required to teach the clients and teams this procedure so that they can determine the goals
and expected/potential outcomes.

Portfolios
In the schools, the Portfolio is a powerful tool for documenting evidence of student progress.
Parents of special needs students often don‟t get the opportunity to see samples of their
children‟s performance over time and often only hear about what their children cannot do.
Portfolios can document what the student can do when tasks and tests are modified to meet
their specific needs. They are also invaluable during times of transition and can support the
learning process that people in a receiving environment must engage in, in order to prepare to
support the student.

There are two main types of portfolios. A process portfolio documents a person‟s learning over
time and demonstrates progress. A product portfolio is designed to demonstrate mastery and
would contain only best work. Both types of portfolios are useful to anybody who wishes to
show others what he/she is capable of.

Analyzing Data

Once data has been collected, it can be analyzed according to the chosen intervention model.
Communicative Independence can be observed, Communicative Competencies can be
measured, Social Networks can be examined and Access and Opportunity barriers can be
evaluated. Progress can be tracked and new goals and objectives targeted.

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Reporting Data

Progress and performance can then be reported in the “Individualized Education Plan” (IEP) at
school and in “Care Plans” at residential facilities or health units in the adult world. This data is
important because it ensures that behaviours are monitored and skill development is tracked,
and that we do not lose sight of either baseline skill level or the goals for the future. For
example, many adults actually become more restricted in their communication and abilities after
years in residential care. Additionally, data collection is important in monitoring quality of care.
When plans are documented they are less likely to be lost. Finally, data collection on a larger
scale can be used to justify requests for additional funding.

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Section 3: Voice Output Communication Aids

Technical & Non-Technical Communication Systems

Technical and non-technical communication systems may address different people‟s needs.
Non-technical systems can be very effective with familiar partners. This can be especially true
for the person who does not use direct selection for access. Eye-pointing on an e-tran may be
faster, with familiar partners, than selecting messages through electronic scanning and switch
use. Non-technical systems can also be very effective in situations where vocabulary updates
and other system maintenance must be done quickly.

Voice output technology may be necessary when the person needs to speak with groups and/or
people who can‟t see and interpret non-technical selections. The young student who needs to
increase social interactions with peers may benefit from voice output for initiating these
interactions and using the same phrases and intonation as other students. Voice output can be
beneficial for the secondary student and adult who is meeting more unfamiliar partners.

People who are non-verbal should always have a non-technical communication system in place.
When necessary, voice-output technology should be available as well. The needs addressed by
technical and non-technical systems may be different, and system messages and
implementation should reflect this.

The following section describes the features and possible uses of different types of voice output
communication aids. This information allows for a comparison of the main categories of VOCAs
and will assist in the process of matching technology to individual needs. Durability and after-
market support are very important features to consider as well. Within each category, examples
of specific products are provided. Of course, all AAC technologies on the market are not able to
be listed here.

In this document devices are placed into the following categories:

single message
multiple message
dynamic display
icon sequencing
text to speech

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Single Message Devices

A single message device is used for inclusion and participation, can be easily programmed and
reprogrammed, can be pressed directly or used with a switch, is battery operated, is portable,
and has approximately 20 - 75 seconds of digitized speech

Peter is a 22 year old non-verbal adult with multiple handicapping conditions including cerebral
palsy, cortical visual impairment and a moderate cognitive deficit. Peter‟s arms and legs are
very spastic. His legs stiffen into extension. His arms are flexed in a total flexion pattern.
Amazingly he manages with his right hand to use a customized joystick to operate a power
wheelchair in learned settings both indoors and outdoors. He loves music and plays the drums.
He uses adapted drumsticks and is able to hit the drums and keep the beat. Peter loves being
with people. He interacts with others through smiling and laughing. He has a great sense of
humour.

When presented with familiar objects, he can communicate acceptance and rejection. He
smiles if he likes something and ignores or turns his face away if he doesn‟t want something.
Now that Peter is a young adult living in a group home, he does not have as many
communication partners as he did when he was attending school. He appears more isolated
and less satisfied with the quality of his life. He needs a way to interact with the people that he
sees regularly on an everyday basis. He also needs a way to get the attention of unknown
people that he encounters in the community. Peter has enough controlled movement in his right
hand that he can hit a single switch.

In addition to collecting information through observations and talking to people who know Peter
well, the Participation Model was used to further identify Peter‟s communication needs. The
Participation Model is an assessment and intervention model by Beukelman and Mirenda (1998)
that compares the functional participation of persons using AAC with same age peers. Other
members of the group home were observed to gain the attention and greet both familiar and
unfamiliar people. They could engage in interactive communication with their peers and
caregivers in their environment. Peter was unable to participate in a similar manner to his
peers.

It was decided that a single switch communication device that would record a sequence of
messages would meet Peter‟s communication needs. The device that was chosen was the
Step by Step Communicator with levels.

Peter‟s communication goals emphasize his emergent communication needs. Jokes recorded in
multi-steps enable Peter to interact with familiar people. Jokes make the listener laugh which
Peter loves to do. In addition, Peter is learning about getting the attention of the listener and
turn-taking in conversation. A series of greetings recorded on the Step by Step enables Peter to
interact with unknown people he meets in the community. Recently Peter has become the
official greeter in his family‟s church which has brought him and others much joy. This could
possibly develop into a job for Peter. For example, he could possibly become a Wal-Mart
greeter for an hour or two a week.

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Client/ Student needs to be able to:

depress a switch with some part of the body that has purposeful movement
o a smaller switch can be connected to the device if the client would have more
success hitting a smaller, strategically placed switch rather than the actual device
really no other prerequisites – user will develop skills by using the device

Team needs to be able to:

record appropriate messages on the device
make sure device is available for the client‟s use
provide opportunities for the client to use the device
make sure the battery is charged
measure progress of client and team

Examples of uses for single message devices:

initiating or entering a conversation – ”Come over here; I have something to tell you from my
communication book.”
calling for attention – “Hey guys, you forgot about me.”
message delivery – “Here‟s your attendance sheet.”
games - Red Rover Red Rover, Simon Says.
requests – “I need a break.” “I need some help.”
jokes - Retell a favourite joke.
greetings – “Hey! How‟s it going?”
comments – “I can‟t believe it!” “You look maaaarvelous.”
literacy - production of a line or a repetitive phrase during a class reading. Appropriate
sound effect during a story, e.g. for Cookie Monster book – “Yum, yum, yum”
work experience – “The sewing machine needs re-threading.”
drama and presentations - “Speaking” lines from a play, poem or report.
giving instructions - Student presents instructions that would normally be given by a teacher,
e.g. “Put your name on the test, and number your paper from 1 to 35.”
songs - “Sing” the song chorus or add sound effects.
adjunct to a more sophisticated communication device - Single message devices may be
reprogrammed quickly for a fast-changing situation. These devices may also be more
portable for certain situations. A single message device, paired with a voice output
communication aid with multiple message choices, may be the technical solution for some
students.

For more curriculum ideas, see work by Peggy Locke and her colleagues at AbleNet.

Something to think about….If a client is using his single switch device to make a request such
as “I need a break” and is learning to use the device whenever he needs to communicate this
message, it would not be a good idea to change the message. If the client was getting
frustrated and hit his switch to communicate that he needs a break and he got another message
instead such as “Hey, How’s it going?”, it could confuse and further frustrate him.

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Examples of single message devices:

BIGmack Communication Aid, AbleNet, Inc.
Step-by-Step Communicator, AbleNet, Inc.
Hip Step Talker, Enabling Devices, Inc.

This BIGmack is programmed to sing “Happy Birthday”.

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Multiple Message Devices

Multiple message devices are dedicated communication devices with more that one message
appearing at a time, which utilize recorded speech and paper communication overlays. They
can have multiple levels, varying lengths of „talk time‟ and come in many shapes and sizes.

Debbie is 24 years old, has a diagnosis of „on the autism spectrum‟, walks, does not talk and
lives in a group home setting with two other clients. If she is interested in the topic, she will
engage in it for up to half an hour. She will remember routines and smile, giggle and participate,
and then she will toss the objects when she is finished. She dislikes getting up in the morning,
going to bed at night and any unexpected changes in her routine. Her weekly leisure activities
are: swimming, library, the mall, walks along the river, TV, movies, and monthly dances. Her
household chores are: grocery shopping, laundry and taking dishes in and out of the dishwasher

Debbie communicates for the functions of: greetings (waves, makes a vocal approximation),
requesting (gets object, uses symbol binder if on appropriate page for the activity) and
protesting (pushes, throws).

She requires interpretation of her communication messages in order to be understood. She will
point to symbols in a binder organized by activity. She uses mostly nouns, but will create two
and three word sentences if prompted. Debbie found dynamic displays overwhelming and
confusing; they were too heavy and the symbols were too small for her to see on palm top
devices. She had access to a classroom computer at school and used software such as
Bailey‟s Book House. Her group home has an XP desktop computer with a colour printer.

Debbie‟s communication partners are: Mom, Dad, adult siblings, group home staff, fellow group
home clients, casual acquaintances she meets in the community (some of whom may also use
AAC) and strangers (e.g. store employees and bus drivers).

Based on the information gleaned from observing Debbie and interviewing significant others in
her life, it has been determined that the following components will make up her individualized
AAC system:
A multiple message device with overlays created to communicate in the environments of:
the mall, walks, TV/movies, groceries, laundry, dishes and social chatting.
Keep the current symbol binder and add printed copies of any new overlays into it for
back- up.
Symbol pages for the communication activities of: swimming (bungee cord the page to a
flutter board), library and walks (for when it rains), meals (on a placemat) and washroom
activities (on the walls).
Her personal dictionary needs to also document her gestures, body language and sounds
that are communicative.

It was decided that a multiple message device such as the Tech Speak was the most
appropriate device for Debbie to use at this time.

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Debbie‟s overall communication goal is to learn how to use the components of her AAC system
to communicate effectively in the environments that she lives in. The initial objectives for her
device are learning to operate the on/off switch and volume control appropriately (operational
competency); learning to independently combine 2 symbols to create a two word sentence
(linguistic competency); learning to ask staff how their time off was, ie “How was your
weekend/day off?” (social competency) ; and learning to use the symbol “what I want to say is
not on my device” instead of acting out or throwing the device(strategic competency).

Client / student needs to be able to:

activate the device or switch
understand several symbols
make choices

Team needs to be able to:

determine the vocabulary and layout
create the device overlays
teach how to use the device
monitor the use so vocabulary remains current.

Other considerations:
laminating the overlays will make them more durable and easier to insert into and remove
from the device
another person records the messages into the device. Then at some point the
Client/Student will activate the square and the message will be spoken. So while it is
important that the person recording the message be as close as possible in age and gender
to the person who will be using the system, it is not mandatory. If no one else is available
and a message needs to be changed, change it. It is the content of the message that is the
most important thing.

Examples of uses for multiple message devices:

consistent activities - preprogrammed vocabulary to increase level of participation in various
community and educational opportunities
literacy participation - retelling, or sequencing stories with each square being a new line or
phrase
academic subjects - oral report giving, theme related vocabulary for participation or
answering questions in class
social conversations - sharing information, restaurant vocabulary for dining out, or enquiring
about somebody‟s weekend
supporting independence - making choices, anticipating transitions, staying on task.

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Example of an overlay for a lunch time conversation.

Features of multiple message devices:

allows message selection from a set of choices
provides opportunities for sequencing symbols
increases potential for more independent communication and participation
can use with one or more overlays
can customize size and number of messages within device boundaries
can often accommodate head pointing, scanning or other access methods.

Examples of multiple message devices:

TechTalk/Speak/Scan, Advanced Multimedia Devices, Inc.
Message Mate, Words+
Advocate, DynaVox
GoTalk, Attainment Company, Inc.
Auditory Choice Making Communicator, Enabling Devices, Inc
Partner 4, Advanced Multimedia Devices, Inc.
7 Level Communication Builder, Enabling Devices, Inc.
iTalk2, AbleNet, Inc.

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Dynamic Display Devices & Software

Dynamic Display devices utilize a computer screen with picture symbols. When certain symbols
are activated, the display then changes, providing a new set of symbols and messages. All
symbols, messages and displays can be programmed and modified specifically for the student
by the team.

Cole is a student in Grade 8 who experienced a Traumatic Brain Injury (TBI) as a young child.
He uses a walker and has difficulties with fine motor tasks such as writing, drawing, and
keyboarding. He does not have recognizable speech, but can indicate yes/no with gestures and
sounds.

Cole has a modified curriculum at school. He has developing literacy and math skills, but these
are at the Kindergarten - Grade 1 level. Cole has one resource block per day at school and is
integrated into regular classes, although he is not doing the same work as his peers. He
receives support from an educational assistant at school.

Cole loves interacting with peers at lunch. However, he‟s an observer rather than an active
participant. He loves listening to music and swimming. He lives with his mom and younger
brother.

Cole‟s communication profile is that of a Context-Dependent Communicator. He communicates

well in structured environments with adult partners. However, he does not tend to communicate
in open-ended situations, does not initiate communication often, and communicates with few
peers.

Cole communicates non-verbally without hesitation, but needs encouragement to use his
communication book. He responds to others‟ communication more than he initiates.
He has limited communication functions and, for example, rarely comments. He has difficulties
building a topic and „conversations‟ are usually short. He is able to move between pages of his
communication book, but uses single symbols to communicate. He will repeat a two symbol
phrase if it is modeled. The team feels he is ready for a dynamic display communication device.

Cole‟s communication goals are equally balanced in content, form, and use. Cole‟s team has
prioritized that he learns new vocabulary, begins to combine vocabulary into two-symbol
combinations, and that he use his communication book meaningfully.

Cole will use his communication book to respond to questions from his teacher as well as
questions from his peers. His teachers, E.A. and therapists will model communication using two-
word combinations. His peers will model answers in group activities using a duplicate
communication book. As well, he will learn one new symbol a week and will have the
opportunity to use it at least 10 times during the week.

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Cole‟s team decided on a MightyMo dynamic display device from DynaVox Technologies.

Client/student needs to be able to:

recognize pictures and/or auditory prompts
categorize vocabulary into meaningful groups
understand number, order, and sequencing concepts
recall what messages are available on various displays and navigate to them
remember desired message as they move through the displays to construct it
It is helpful if the student/client is already familiar with using several displays in a non-
electronic format, such as a communication book.

Team needs to be able to:

choose the appropriate vocabulary
teach the location and use of the symbols in the device
learn to program individualized messages
allow time to program individualized messages
allow adequate lead time for the programmer to program and teach appropriate fringe
vocabulary

Examples of uses for dynamic display devices and software:

Dynamic displays can be created for any activity at school or home, from informal
interactions to sentence construction.

Features of dynamic display devices and software:

multiple access methods including mouse, joystick, touch screen, switch, head pointer, etc.
speech is either recorded/digitized or computer generated/synthesized
varying degrees of portability specific to device.

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Examples of dynamic display devices:

Tango, Blink-Twice
IChat3, DynaVox Technologies
V and Vmax, DynaVox Technologies
DV4 and MT4, DynaVox Technologies
MiniMo and MightyMo, M3 DynaVox Technologies
Eco-14, Prentke Romich Company (PRC)
Vantage/Vanguard, PRC
Springboard, PRC
Chat-PC, Saltillo
Tufftalker and Freedom Toughbook, Words+

The Tango has synthesized speech and displays 6 choices at a time. Arrow keys move you
to menus, to more choices, or back a level.

Examples of Dynamic Display Software:

Series 5 Speaking Software, DynaVox Technologies
Speaking Dynamically Pro (SD Pro), Mayer-Johnson, Inc.
Talking Screen, Words+
Say-it! SAM PC, Words+
Communicator 3, Viking Software

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Sample screens from a Speaking Dynamically Pro software. The “school”

button on the display above is connected to the following topic boards.
Each topic board contains sub-topics and/or phrases and vocabulary.

Examples of Additional Board Sets:

WordPower and Picture WordPower for DynaVox or PRC Devices
WordCore and AQLS for PRC Devices
Functionally Speaking for SD Pro
Quickpage for Talking Screen, Words+
Velocity, DynaVox Technologies

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Picture Word Power is designed to allow access to over 100 core vocabulary items with a single
hit. Linked page buttons are shaped as file folders. An onscreen keyboard includes word
prediction.

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Icon Sequencing Devices

Icon sequencing is based on the concept of semantic compaction which means that an icon can
represent more than one thing dependent on its sequence with other icons. For example, when
an apple icon is selected, food group pages can be accessed as well as the verbs “eat” and
“feed”, the adjective “hungry” and the group noun “food”. This organizational system in a
communication device is faster than spelling letter by letter, provides easy access to core
vocabulary related to topics and has accessible grammatical markers in order to produce
complete and grammatically correct output. The main symbol set used in icon sequencing is
Minspeak.

Scott is an 8 year old boy with Cerebral Palsy who is in grade 2. He is just beginning to walk
short distances with a walker. Scott has adequate control of both hands to use direct selection
with his index fingers.

Scott‟s cognitive skills fall within the low average to average range. He is an emergent reader.
He is an independent communicator. He uses total communication, initiating and maintaining
communications using a variety of methods including his MightyMo (which he received in
Kindergarten), his communication book, gestures, vocalizations and facial expressions.

The user abilities that determine which communication device would benefit Scott in providing
generative speech include; the ability to understand many symbols, make choices amongst
those symbols, understand categorical concepts and patterns, remember where symbols are
stored, and understand that icons can represent a variety of word is important when looking at
Icon sequencing devices.

Such a device would also need to allow the pre-storage of longer messages, support emerging
literacy, be portable and allow for keyboard emulation.

Scott‟s team chose the Vantage with the Unity 45 full user area as the appropriate device to
meet his communication needs.

The goals the team chose to work on included learning the location of the basic core vocabulary
and increasing sentence length (Linguistic competency); learning to independently set up
keyboard emulation as well as the Icon Tutor to learn the icon sequences that represent words
(Operational competency); learning to use quick hits to gain turns in the classroom and learning
to use the Notebooks to prepare and store information for later delivery (Strategic competency);
learning to use the Vantage to communicate with minimal support in most environments and
communicating with unfamiliar partners and in unfamiliar contexts. (Social competency)

The Vantage should be used throughout Scott‟s day as his voice to participate in classroom and
community activities. It should be used to ask and answer questions, to read, to write and to
interact with others.

Client /student needs to be able to:

• activate a device directly or use an alternate method
• understand many symbols
• understand that icons can represent a variety of messages
• make choices from a large set

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• remember where symbols are stored

• understand how words are combined to form messages
• read and spell at a basic level
• understand categorical concepts and associations

Team needs to be able to:

• understand and support icon sequencing
• commit team time to teaching the system
• learn the architecture of the system in order to customize successfully

Other considerations:
because of the complexity of this kind of device, active involvement of a Speech Language
Pathologist is strongly recommended for successful implementation

Examples of messages:
I want peanut butter and jam on my toast, please.
I had an awesome time at the movies with my friend last night.

Uses for icon sequencing devices

Icon sequencing devices are intended for generative communication in all settings for all
communicative functions. They are designed to produce complex language which can be
spoken orally or produced in written form.

Features of icon sequencing devices:

multiple access methods including screen, optical light pointer, infrared light pointer or
switch activated scan (both visual and auditory)
synthesized, digitized and RealSpeak voices
keyboard emulation

Examples of icon sequencing devices:

Pathfinder, Prentke Romich Company
Vanguard, Prentke Romich Company
Vantage, Prentke Romich Company
ECO-14, Prentke Romich Company (software of all Prentke Romich devices integrated into a
tablet)
ChatBox, Saltillo

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The Vantage with Unity 45 Full provides access to a

large vocabulary and uses Minspeak symbols.

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Text-to-Speech Devices
Text-to-Speech devices allow for the user to type messages which appear on the device‟s
screen. The text is then spoken using synthetic speech. These devices come in a variety of
sizes, allow for different access methods, can use word prediction and abbreviation expansion
to enhance text input and can allow for instant messaging

Talia is in grade 12 student who has progressive polyneuropathy, a degenerative disease

resulting in increasingly flaccid tone and poor muscle strength. Her cognitive skills are within
normal limits. Her language comprehension is within normal limits, and she has low-average
reading comprehension and spelling. Expressively, she initiates communication, directs her own
care, and is capable of complex grammatical output. Fatigue is a significant issue for Talia.

Talia is auditing two grade 12 courses, Communication 12 and Law 12, and volunteers one day
weekly at a local preschool. She enjoys social opportunities, watching sports, and listening to
garage bands.

Talia uses a Lightwriter which she now accesses by both direct selection and by Morse code
using 2 switches on her wheelchair‟s head rest. She also uses a plexiglass E-Tran for
communication when she is out of her wheelchair.

The team that chose the Lightwriter had only looked at devices that support Morse code input.
This is because of the typical progression of Talia‟s medical condition. Talia likes the dual
screen nature of the Lightwriter because it allows the communication partner to be in front of her
instead of behind her when they are reading her messages. She also likes the female voice the
device has. Talia prefers to enter commands and text directly as opposed to navigating through
pages on a computer based device.

Talia has been learning Morse code since Grade 9. A major communication goal is to learn to
function at an automatic level when inputting Morse code. If she has to think too much while
inputting using Morse code she fatigues and is less likely to communicate. She needs to spend
direct time drilling and rehearsing her skills on the Lightwriter. She needs guided practice within
all her communication environments.

Another goal is to continue to identify communication breakdowns and look for repair strategies
when needed. She uses strategies effectively and will benefit from continued support in these
areas.

In addition to developing Talia‟s operational competence by teaching her about the device‟s
capabilities, she also needs to further develop her social competence. In other words, she
needs to learn the most effective ways for talking to others in her environment in addition to
developing technical skill with her AAC system. Moreover, the others in her environment need
to learn how best to interact with Talia.

Because Talia has a degenerative condition future needs are an important consideration. Her
current communication needs must be addressed but always in the context of how her current
communication system can be adapted as her physical abilities change.

It is not anticipated that Talia will change her access method once she is using Morse code.
The Morse code will serve her until fatigue and muscle weakness prevents any controlled

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movement. Follow-up therefore consists of monitoring Talia‟s physical status and continued
teaching for optimal use of the Lightwriter.

Client/student needs to be able to:

have functional spelling
either have the physical range and dexterity to access the keyboard or
have attention skills adequate to support scanning or Morse code input
have critical thinking skills and adequate memory to store and retrieve abbreviations and
stored messages, or to learn other rate enhancement strategies

Team needs to be able to:

monitor posture and placement of the device and any switches
maintain charge on the device
teach her to use the device‟s features and to problem-solve for optimal accuracy and
efficiency
teach her to take responsibility for communication. Transparent output permits
communicative independence for the user even with unfamiliar listeners.

Other Considerations:
a variety of access options including Morse code permits spelled out generative
communications
connection to computer, phone, or printer
an experienced trainer is required to advise the user on how to code and store messages
and abbreviations
teaching the user how to program the device will empower him/her to use it at optimal
efficiency
mounting is crucial so that user has continual immediate access to device

Examples of uses for text-to-speech devices:

face to face communication with unfamiliar communication partners as well as those who
are familiar
many devices have word processing features for academic work
make competitive employment a possibility (provided reciprocal conversations at typical rate
are not required)
in terms of communication, a capable user can be unattended in the community because no
interpretation is needed

Features of text-to-speech devices:

synthetic speech
form factor: size, keyboard versus tablet
user types messages, which appear on a screen.
configurability of the keyboard, access options
rate enhancement strategies
o word prediction
o abbreviation expansions
combination digital-synthetic speech for instant messaging or voice banking
combination symbol- alphanumeric software and devices
devices may connect to computers and phones and may have infrared capabilities

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Examples of text-to-speech devices:

Lightwriter, Toby Churchill
Link Plus, Assistive Technology Inc
Chat PC, Saltillo
Chatbox40 XT, Saltillo
Dynawrite, DynaVox Technologies
V, VMax, DynaVox Technologies
Palm3, DynaVox Technologies

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Appendices: References & Resources

Appendix A: Glossary
AAC: See augmentative and alternative communication.

AAC system: Also known as a communication system. An integrated system of communication

components, including strategies, techniques, skills and devices that are used to communicate.

Abbreviation expansion: The expansion of either typical (Dr = doctor) or user specific (jc =
juice) abbreviations that transmit complete messages with a reduced number of keystrokes.

Abstract: When referring to symbols, a term meant to describe intangible concepts such as
beliefs, emotions and ideas. With graphic symbols, abstract referents are difficult to represent in
pictures and tend to be more commonly represented by arbitrary symbols.

Accessibility: When referring to AAC systems, the ability to select or activate components of
an AAC system in order to communicate. The term accessible is most often used to describe
parts that an individual can physically manipulate, e.g. switch.

Activity / standards inventory: An inventory developed by Beukelman and Mirenda that

measures the level of participation of a person who uses AAC. The inventory also identifies
barriers to participation across a variety of activities.

Aid: An assistive tool (e.g. communication board, communication software) that supports or
acts as an alternative to natural speech or writing.

Alternative communication: A communication system that is an alternative to natural speech

or writing.

Alternative input devices: Devices or tools that provide individuals with access to
communication systems other than through direct selection, e.g. switches.

Alternative keyboard: A keyboard that is used in place of the regular keyboard. This type of
hardware can be configured to meet the specific needs of the individual, e.g. IntelliKeys.

Aphasia: A condition resulting from damage to certain parts of the brain in which
comprehension and formulation of language is impaired. Various aspects of communication can
be affected including comprehension, speaking / signing, reading and writing either individually
or in combination.

Apraxia: A condition resulting from damage to the motor control areas of the brain, which
results in an inability to execute voluntary movements. Apraxia of speech is characterized by
trouble sequencing and coordinating speech movements.

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Arbitrary: A term used to describe symbols that do not have an obvious relationship to their
referents. These types of symbols must be learned.

Assistive technology: Any technology that is used to help people perform tasks that are
difficult or impossible due to disabilities.

Auditory scanning: A type of scanning for message selection in which the names of items can
be heard during the scan.

Augmentative and alternative communication (AAC): A communication approach that

augments or provides alternatives to natural speech or writing for persons with severe
communication disorders. The term also refers to the related field of practice.

Automatic linear scanning: A technique for message selection in which the movement
through the choices automatically and continuously moves according to a preset pattern. The
person must stop the scan to make a selection.

Basic-choice communicator: An individual who requires the maximum support from

communication partners to make basic choices.

Block / group scanning: A message selection technique in which blocks or groups of items are
initially selected. The number of items in each block decreases as the person makes selections.

Cause and effect: A relationship between two events where one causes the other, e.g. hitting a
switch causes a toy to move.

Circular scanning: A technique of message selection in which a pointer (like a clock hand)
moves in a clockwise/counterclockwise direction, pointing at items or messages.

Collaborative consultation: A process that involves consultation among team members,

usually with a variety of backgrounds and expertise, to generate solutions to problems.

Communication board: A low technology communication device that displays symbols,

pictures, or text to convey messages and meaning.

Complexity: In AAC, this refers to the physical complexity of a graphic symbol (the detail, the
degree to which it stands out from the background, etc.) or the complexity of movement and
handshape of a manual sign.

Computer-based communication system: A computer system that has software specific to

supporting and enhancing the individual‟s communication.

Concrete: A term used to describe tangible referents like people, places and objects, e.g., a
picture of an apple to represent an apple.

Congenital disability: A disability, usually as a result of injury or disease, that is present at

birth.

Core vocabulary: Words and/or messages that have universal utility for most individuals.

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Coverage vocabulary: A limited number of words and/or messages that allows the individual to
communicate on a variety of topics.

Criteria-based assessment: Assessment, based on predetermined criteria, designed to show

whether an individual‟s skills are sufficient to utilize a specific AAC system.

Daily routine diary: A record of words, phrases and sentences; this is a tool that is useful in
identifying an individual‟s vocabulary needs to support participation in daily routines.

Dedicated communication device: A device specifically designed to be used for

communication. It may also be interfaced with a computer, environmental control unit, etc.

Degree of ambiguity: A measure of the number of concepts associated with a particular

symbol. The more meanings for a single symbol, the greater the degree of ambiguity.

Developmental disability: A disability that is present before adolescence or adulthood that

affects specific areas of development like cognition, communication, etc.

Digitized speech: Speech produced electronically when human voice is recorded and digitized.

Directed scanning: A technique of message selection in which the user directs the movement
of the scan, in four or more directions, by controlling a switch (or joystick).

Direct selection: A method of selection in which an individual using AAC uses a body part or
prosthesis to indicate choices on a communication device, e.g., touching, gazing with eyes, etc.

Dvorak keyboard: A keyboard layout that allows a person who types with one hand to quickly
access the most commonly used characters.

Dynamic display: A visual display that changes.

Dysarthria: A speech disorder due to a disturbance in muscular control of the speech

mechanism. This can affect speed, pronunciation and loudness of speech.

Echolalia: Human speech which echoes words spoken by others.

Enhancement: The provision of visual clues to help clarify symbol meaning. They are usually
faded out over time so the individual learns the meaning of the original symbol.

Environmental control unit (ECU): A device that provides remote control over objects, like
fans, lights, or televisions in their environment.

Environmental inventory: A tool for gathering information on an individual‟s interest and daily
activity vocabulary needs.

Errorless learning: A term used to describe learning in which few or no errors occur.
Procedures such as stimulus shaping, fading and most-to-least prompting are used to ensure
the learner has the maximum opportunity for success.

Expanded keyboard: A keyboard with a touch sensitive membrane surface that can be
configured to meet the needs of an individual with motor disabilities, e.g. IntelliKeys

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Eye gaze: A term used to describe the act of looking at a specific location, area or symbol.
Used by some individuals for communication.

Fading: The gradual reduction of prompts used to assist an individual in producing a response.
When fading has been accomplished, responses are produced without any prompts.

Feature matching: This term describes a process in which features on an AAC device are as
closely matched as possible to an individual‟s communication needs.

Figure: With respect to graphic symbols, that part of the symbol that carries the important
information or meaning of the symbol.

Fitzgerald key: On an AAC communication board, a colour-coded organizational scheme that

arranges the symbols/keys from left to right in subject-verb-descriptor-object/place order.

Functional communication: Communication that allows an individual to express basic needs

and wants, transfer information, and communicate socially with others. Functional
communication is needed to establish an individual‟s independence.

Generally understood gestures: A set of gestures understood by the general population, used
with and by individuals with severe cognitive disabilities.

Gesture dictionary: An inventory of gestures that are used or understood by an individual for
communication.

Global aphasia: A neurological condition in which there is extensive impairment in all areas of
speech-language.

Gloss: A printed word that accompanies a graphic symbol.

Ground: Contextual information of a graphic symbol that enhances the meaning of that symbol.
It is important that there is good discrimination between the ground and figure.

Head pointer: An adaptive device that can be used for direct selection. It may be affixed to an
individual‟s head, usually with a band or helmet.

High technology: A device that has synthesized speech and print output as well as
programming/editing capabilities. Most often found in the “dynamic display”, “icon sequencing”
and “text-to-speech” categories.

Icon: A symbol or picture that represents a referent.

Icon prediction: Minspeak feature that allows the individual faster retrieval of stored messages.
It requires less cognitive effort as icons associated with the first selected icon are lighted.

Ideograph: A graphic representation that suggests rather than actually depicts its referent.
They are typically used with more abstract referents.

Idiosyncratic gestures: Gestures used consistently by one individual only. They remain
idiosyncratic as long as others don‟t adopt and use them (thereby becoming conventional).

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Inclusion: An educational philosophy that allows for children with disabilities to be in the same
setting as those children who do not have disabilities.

Individualized education program (IEP): An educational program designed by a school based

team to meet the unique needs of a specific student.

Integrated environments: Settings where individual students with disabilities function

alongside student peers without disabilities.

Intelligibility: The ability of a symbol to be identified and understood without prompts or

explanations.

Intervention: The provision of services designed to improve communication so that an

individual can more fully and more effectively participate in daily activities.

Inverse scanning: A message selection technique in which activating the switch begins the
scan and releasing the switch stops the scan and selects an item.

Joystick: A computer input device used to control movement of an object/cursor on the screen.

Language use: The pragmatics of language that have to do with an understanding and an
ability to engage in social exchange with others.

Level of abstraction: The amount of detail in a symbol – the less detail depicted, the greater
the level of abstraction and vice versa.

Lexicon: A collection of vocabulary words and/or manual signs.

Linear scanning: A message selection technique in which items are scanned individually in a
specific sequence (like a row or circle).

Linguistic competence: In AAC, mastery of an AAC system‟s symbols and symbol

arrangement to effectively communicate with others.

Lite technology: A battery or electrically powered device that produces digitized speech. Most
lite tech devices are found in the “single message” and “multiple message” categories.

Logic: A term applied to symbol sets where inherent conformity to a set of rules allows creation
of new symbols to be consistent with those already in the system.

Logograph: A letter, character or other graphic symbol used to represent a word.

Memory-based encoding: The process of forming language in which the storage and retrieval
organizational scheme is committed to memory (i.e. not a chart based system).

Message: A communication that conveys meaning and has a purpose.

Microboard: is a small group of family and friends that join together to create a nonprofit
society, aiming to address a person's needs in an empowering and customized fashion.

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Mini keyboard: A small keyboard with small keys arranged in a tight configuration for people
with limited range of motion.

Minspeak™: A system of encoding and organizing messages for storage and retrieval based
on the use of icons that have multiple meanings.

Morse code: An international system of dots and dashes that can be used through
communication devices for output as letters, punctuation and numbers.

Mouthstick: An adaptive device held in the mouth and used to direct select a desired object /
picture / word from an array of choices.

Multimodal approach: An intervention approach that uses more than one mode of
communication, e.g. gestures and graphic symbols

Needs assessment: An assessment of the communication needs of a person using AAC for
the purpose of determining which AAC device would best meet his or her needs.

Nonlinguistic communication: Vocal, graphic or gestural communication that uses symbols

normally not part of a linguistic system. This includes some vocalizations (pleasure, discomfort),
line drawings and gestures.

Nonverbal: An ambiguous term that technically means “without language”. It is occasionally

used to describe individuals with little or no functional speech.

Opaque: A term used to describe symbols that have no or very little visual resemblance to their
referents.

Operational competence: The ability to independently and effectively use an AAC system.

Output: The product of aided high technology AAC systems, including voice and/or print.

Participation model: An assessment and intervention model by Beukelman and Mirenda

(1998) that compares the functional participation of persons using AAC with same age peers.

Partner assisted scanning: A message selection technique in which a communication partner

provides scanning by presenting items through spoken, visual or tactile means.

Phoneme: A speech sound.

Phonologic awareness: The ability to consciously reflect on the sound system of a language,
to manipulate its structure and to recognize differences and similarities in phonemic properties.

Pictograph: A symbol that depicts an abstract or concrete referent using simple pictures or line
drawings.

Picture Communication Symbols (PCS): A large set of aided symbols made up of mostly line
drawings with the words printed above them.

Portability: A consideration when selecting an AAC device or system that must be transported
by an individual.

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Pragmatics: The use of language in communicative contexts – relates to how the message is
related rather than content.

Pre-literate: A term used to describe an individual who has not yet learned to read and write but
appears to possess the cognitive ability to do so if given the opportunity.

Prompts: The form of assistance or stimulus given to an individual to help produce a desired
response or behaviour. Prompts can be verbal, gestural, physical and/or visual.

Reaction time: The time between stimulus and response.

Rebus: A representation of syllables or words by pictures with names that sound the same as
the intended syllables or words.

Receptive vocabulary: Words and messages that are received and understood by a listener.

Referent: A person, place, object or abstract idea that is represented by a symbol.

Row-column scanning: A message selection technique in which scanning occurs down rows
until the user interrupts the scan and then continues across the columns in the selected row.

Scanning: A message selection technique in which items are presented sequentially.

Scripting: Breaking an activity down into small steps and then recording the expressions and
words needed to participate in the activity.

Semantic compaction: The encoding system used in Minspeak™ in which many associations
are made with each icon.

Semantics: The meaning system of language.

Sigsymbols: A graphic symbol system of pictographs and sign-linked symbols that is

composed of graphic representations from British or American Sign Language.

Social competence: The ability to communicate appropriately in social situations (when and
what to talk about).

Speech generating device: A term created by Medicare in the USA to identify a range of voice
output AAC systems. For funding purposes, Medicare has established codes to categorize
SGDs by features. Many devices that are acceptable to Medicare have been “locked down” so
that features other than speech output (ie. writing and internet access) are not available.

Speech Language Pathologist (SLP): A professional who is licensed to work with individuals
with communication disorders.

Speech Language Pathology Assistant (SLP-A): A person who is employed to assist the
SLP in the creation and production of AAC systems and training in their use.

Speech synthesis: Computer generation of speech from typed text or stored messages.

Static: A term used to describe symbols in which no movement is needed to convey meaning.

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Step scanning: A message selection technique in which the individual moves through a
patterned array of items by activating a switch each time to move to the next item. Choices are
made by activating a second switch or utilizing a dwell feature.

Switch: A component of some AAC systems which acts as an interface with a communication
device, allowing the user to make selections by scanning.

Symbol: Something used to represent another thing or concept. AAC symbols can be acoustic,
graphic, manual and/or tactile.

Symbol set: A defined number of symbols. It can be expanded but lacks clearly defined logic
or rules for expansion.

Symbol system: Symbols designed to work together for maximum communication. Includes
logic or rules for expansion.

Syntax: The structural or grammatical aspects of language.

Synthesized speech: Speech that is artificially produced by means other than the human vocal
tract.

System efficiency: The relationship between symbols/activations and the number of messages
they convey. The more efficient the system, the less activations are needed to generate the
most messages.

Tangible consequences: Positive reinforcement given by an individual‟s getting or maintaining

access to tangible items like food or toys.

Tangible symbols: A set of real objects, miniature objects, or parts of objects that can be
organized as an AAC system.

Text-to-speech synthesis: The creation of artificial speech by typing on a keyboard or

keyboard emulator.

Touch screen: A transparent interface that is integrated or can be attached to a monitor or AAC
device that allows input or message selection by touching areas on the screen.

Transition services: The process and/or delivery of services involved when an individual
moves from home to school, school to school, or school to work.

Translucent: A term used to describe symbols that are not easily understood without first
knowing the referents. Once the referent is known, the translucent symbol is recognizable.

Transmission: The sending of a message from an individual to a communication partner.

Transparent: A term used to describe symbols that are easily understood because of their
close visual relationship to their referents.

Verbal: A general term that means the use of words, or “with speech”.

Visual scanning: A message selection technique in which symbols are presented visually.

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Visual Scene Display: A picture, photograph or virtual environment that depicts and
represents and situation, place or experience. Individual elements such as people, actions and
objects appear within the scene.

Voice output communication aid (VOCA): An assistive communication device that provides
synthetic and/or digitized speech.

Word prediction: A word retrieval system that helps and increases word retrieval by providing
high frequency words based on initial letter selection. The term also refers to software that
minimizes keystrokes by presenting frequently used words based on input letters.

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Appendix B: References
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Blackstone, Sarah. (2006) Upfront, Augmentative Communication News, vol 18, no 3, p1

Bruno, J. (2003). Test of Aided-Communication Symbol Performance (TASP). Boston:

Children‟s Specialized Hospital Corporation.

Burkhart, Linda (2006). Partner Assisted Communication Strategies for Children Who Face
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Burkhart, L. (1993). Total Augmentative Communication in the Early Childhood Classroom.

Solana Beach, CA: Mayer-Johnson, Inc.

Burkhart, Linda (2006). Partner Assisted Communication Strategies for Children Who Face
Multiple Challenges, presentation at Closing The Gap.

Carlson, F. (1991). DynaSyms Pittsburgh: DynaVox Systems.

Cook, A.M., & Polgar, J.M.; (2008). Assistive Technologies: Principles and Practice, 3rd Ed. St.
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Cottier, C., Doyle, M., & Gilworth, K. (1997). Functional AAC Intervention: A Team Approach.
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Cunningham, P., & Allington, R. (1999) Classrooms That Work: They Can All Read and
Write, 2nd Ed. New York: Longman.

Cunningham, P., Hall, D.P. & Sigmon, C.M. (1999).; The Teacher‟s Guide to the Four Blocks: A
Multimethod, Multilevel Framework for grades 1-3. Greensboro, NC: Carson-Dellosa.

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Downing, J. E. (2005). Teaching Communication Skills to Students with Severe Disabilities, 2nd
Ed. Baltimore: Paul H. Brookes.

Erickson, K. (1999). Balanced Literacy Instruction for all Learners. Presentation for SET–BC,
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Erickson, K. & Koppenhaver, D. (2007). Children With Disabilities: Reading and Writing the
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Fossett, B (1998). Supporting Individuals using Picture Communication Symbols. SET-BC

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Fried-Oken, M. & Bersani Jr., H.A. (2000). Speaking Up and Spelling It Out. Baltimore: Paul H.
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Frost, L.A. & Bondy, A.S. (1994). The Picture Exchange Communication System (PECS).
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Gillis, R.J. (1996). Traumatic Brain Injury: Rehabilitation for SLPs. Boston: Butterworth-
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Hodgdon, L. A. (1999) Solving Behavior Problems in Autism: Improving Communication with

Visual Strategies. Troy, MI: Quirk Roberts.

Hodgdon, L. A. (2000). Visual Strategies for Improving Communication: Practical Supports for
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Lang, S. & Ord, S. (2002). Communication Class: A Communication Skills Course for
Secondary School Aged Students, Vancouver: SET-BC.

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Lesher, G.W., Moulton, B.J., Rinkus, G. & Higginbotham, D.J. (2000) A Universal Logging
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Augmentative and Alternative Communication. Baltimore: Paul H. Brookes.

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Lloyd, L.L., Fuller, D.R., & Arvidson, H.H. (1997). Augmentative and Alternative
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Locke, P. & Levin, J. (1999). Making Connections: A Practical Guide for Bringing the World of
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Inc.

Marvin, C., Beukelman, D., & Bilyeu, D. (1994, December). Vocabulary-use Patterns in
Preschool Children: Effects of Context and Time Sampling. Augmentative and Alternative
Communication, Volume 10, 224-236.

McAvoy, C, et al. (2002), Considerations for Assistive Technology for Students with Multiple
Disabilities. Vancouver: SET-BC.

Millman, Gladys (2006), The Journey from One High Tech Device to Another: How Do You Find
Your Way, presentation at Closing The Gap.

Murphy, J., & Cameron, L. (2001). Talking Mats: A Resource to Enhance Communication.
Stirling, University of Stirling.

Musselwhite, C., & Burkhart, L. (2001). Can we Chat? Co-planned Sequenced Social Scripts: A
make it / take it book of ideas and adaptations. Special Communications and Linda Burkhart.

Musselwhite, C., & King-DeBaun, P. (1997). Emergent Literacy Success: Merging

Technology and Whole Language for Students with Disabilities. Park City, UT: Creative
Communicating.

Newton, C. and Wilson, D.(1996). Creating Circles of Friends. Toronto, ON. Inclusion Press.

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O‟Brian, J. & Pearpoint, J., (1993). Person-Centred Planning with MAPs and PATH. Toronto,
ON. Inclusion Press

Park, Rosemary (2007), Speaking Out: Easier Said Than Done, Vancouver, BC, CAYA

Paul, Rhea (2007). Language Disorders from Infancy through Adolescence, 3rd Ed. St. Louis:
Mosby Elselvier.

Pearpoint, J., O‟Brian, J., & Forest, M. (1993). PATH (Planning Alternative Tomorrows with
Hope): Planning Possible Positive Futures. Toronto, ON, Inclusion Press.

Piche, L., & Locke, P. (1997). 45 Ideas for Using a Beginning VOCA. Presented at Technology
and Persons with Disabilities Conference (CSUN), Los Angeles.

Porter, Gayle (2007), PODDs: Pragmatically Organized Dynamic Displays, Cerebral Palsy
Education Centre & Communication Resource Centre, Melbourne: Australia

Porter, Gayle (2007), Pragmatic Organisation Dynamic Display (PODD) communication books,
Cerebral Palsy Education Centre, Glen Waverley, Australia

Prentke Romich (2000). AAC Teaching Strategies. Wooster OH: Prentke Romich Company.

Reichle J., Beukelman D. & Light J. (2002). Exemplary Practices for Beginning Communicators:
Implications for AAC. Baltimore: Paul H. Brookes

Romich, B.A., & Hill, K.J. (1999). A language Activity Monitor for AAC and Writing Systems:
Clinical Intervention, Outcomes Measurements, and Research. Proceedings for the RESNA
1999 Annual Conference. Long Beach, CA. pp 19-21.

Romski, M. & Sevcik, R. (1996). Breaking the Speech Barrier: Language Development
Through Augmented Means. Baltimore: Paul H. Brookes.

Rowland, C. (2004). Communication Matrix. Portland: Oregon Health & Science University

Rowland, C., & Schweigert, P. (2000). Tangible Symbol Systems. Portland: Oregon Health &
Science University.

Rowland, C., & Schweigert, P. (2004). First Things First: Early Communication for the Pre-
symbolic Child with Severe Disabilities. Portland: Oregon Health & Science University.

Sigmon, C.M. (2001). Modifying the Four Blocks for the Upper Grades: Matching Strategies to
Students‟ Needs. Greensboro, NC: Carson-Dellosa.

Silverman, F. (1995). Communication for the Speechless, 3rd Ed. Needham Heights, MA: Allyn
& Bacon.

Simonsen, A. (1999). Scripted Routines for Students with Voice Output Devices. Vancouver,
BC: SET-BC

Smith, Martine. (2005). Literacy and AAC. St. Louis: Mosby Elsevier.

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Teal, W., & Sulzby, E. (1987). Literacy Acquisition in Early Childhood: The Roles of Access
and Mediation in Storybook Telling. In D. A. Wagner (Ed.), The Future of Literacy in a Changing
World (pp. 111 – 130). New York: Pergamon Press.

Teal, W. & Sulzby, E. (1989).; Emergent Literacy: New Perspectives on Young Children‟s
Reading and Writing. In D. S. Strickland & L. M. Morrow (Eds.), Emerging Literacy: Young
Children Learning to Read and Write (pp. 1 – 15). Newark, DE: International Reading
Association.

Turner, L. (2002). Literacy Activities with Students using AAC Devices. Vancouver, BC: SET-
BC

World Health Organization. (2001). ICF: International Classification of Functioning, Disability

and Health. Geneva: World Health Organization.

Yorkston, K.M. (1992). Augmentative Communication in the Medical Setting. Austin, TX: Pro-
Ed.

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Appendix C: AAC Resources in BC

Assistive Technology Seating Service (ATSS), GF Strong Rehab Centre
4255 Laurel Street, Vancouver, B.C. V5Z 2G9
Phone: (604)734-1313
Website: www.assistive-technology.ca

British Columbia Association of Speech/Language Pathologists and Audiologists (BCASLPA)

9912 Lougheed Highway, Burnaby BC V3J 1N3
Phone: (604) 420-2222
Website: www.bcaslpa.ca

Communication Assistance for Young Adults (CAYA)

105-1750 West 75th Ave, Vancouver, BC, V6P 6G2
Telephone: (604) 261-9450
Website: www.cayabc.org

Provincial Integration Support Program (PISP)

1525 Rowan Street, Victoria, B. C. V8P 1X4
Phone: (250) 595-2088
Website: www.pisp.ca

Provincial Outreach Program for Autism & Related Disorders (POPARD)

4812 Georgia Street, Delta, B.C. V4K 2S9
Phone: (604) 946-3610
Website: www.autismoutreach.ca

Queen Alexandra Centre for Children‟s Health

2400 Arbutus Road, Victoria, BC V8N 1V7
Telephone: (250) 477-1826
Website: www.viha.ca/finding_care/facilities/queen_alexandra_centre_childrens_health.htm

Special Education Technology - British Columbia (SET-BC)

#105 -1750 West 75th Avenue, Vancouver BC V6P 6G2
Telephone: (604) 261-9450
Website: www.setbc.org

Sunny Hill Health Centre for Children

3644 Slocan Street, Vancouver, BC V5M 3E8
Telephone: (604) 453-8300
Website: www.bcchildrens.ca/Services/SunnyHillHealthCtr/default.htm

Technology for Independent Living (TIL)

9007 Shaughnessey Street, Vancouver, BC V6P 6R9
Phone: (604) 326-0175
Website: www.tilbcits.org/

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Appendix D: Websites
1 Voice: Communicating Together. www.1voice.info

AAC and Employment. http://mcn.ed.psu.edu/emp/home.html

AAC Institute. www.aacinstitute.org

AAC TechConnect. www.aactechconnect.com

AbleNet Inc. www.ablenetinc.com

Adaptivation Inc. www.adaptivation.com

Advanced Multimedia Devices, Inc www.amdi.net

American Speech-Language Hearing Association (ASHA) www.asha.org

Aroga Group Inc. http://www.aroga.com

ASHA Division 12: AAC. www.asha.org/about/membership-certification/divs/div_12.htm

Assistive Technology Inc. www.assistivetech.com

Attainment Company Inc. www.attainmentcompany.com

Augmentative Communication Community Partnership Canada www.accpc.ca

Augmentative Communication, Inc. www.augcominc.com

Augmentative Communication On-Line Users Group

www.temple.edu/instituteondisabilities/acolug/

Augmentative/Alternative Communication Intervention Products & Presentations

www.aacintervention.com

Barkley Memorial Augmentative & Alternative Communication Centers http://aac.unl.edu

Blink Twice (Tango). www.blink-twice.com

The Bridge School. www.bridgeschool.org

Bridges Canada www.bridges-canada.com/UI/home.aspx

Paul H. Brookes Publishing Co. www.pbrookes.com

Canadian Association of Speech-Language Pathologists and Audiologists www.caslpa.ca

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Communication Aids for Language and Learning www.callcentre.education.ed.ac.uk

Community Works. www.communityworks.info

Creative Communicating www.creativecommunicating.com/

Design to Learn (Tangible Symbols) www.designtolearn.com

DynaVox Systems www.DynaVoxtech.com

Enabling Devices www.enablingdevices.com

The Four Blocks www.wfu.edu/fourblocks

Gail Van Tatenhove www.vantatenhove.com

Inclusion Press. www.inclusion.com

Inclusive Technology Ltd. www.inclusive.co.uk

Independence, Community, Empowerment (ICE). www.ofcp.on.ca/ice/

International Society for Augmentative and Alternative Communication www.isaac-online.org

Mayer-Johnson, Inc. www.mayer-johnson.com

Oxford ACE (Aiding Communication in Education) Centre www.ace-centre.org.uk

Partners in Communication www.partnersincommunication.com

Penn State AAC Mentor Project. http://mcn.ed.psu.edu/~mentor/

Pittsburgh Employment Conference for Augmented Communicators (PEC)

www.sciconics.com/shout/index.html

Prentke Romich Company www.prentrom.com

Pyramid Educational Consultants, Inc. www.pecs.com

Rehabilitation Engineering Research Center on Communication Enhancement

www.aac-rerc.com

Saltillo Corporation. www.saltillo.com

Simplified Technology www.lburkhart.com/

Talking Mats. www.talkingmats.com

Technology and Integration, Inc. www.tniinc.com

Tobii. www.tobii.com/assistive_technology/home.aspx

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UW Augcomm. http://depts.washington.edu/augcomm/

Words +, Inc. www.words-plus.com

ZYGO Industries Inc. www.zygo-usa.com

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